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Retired NBME 22 Answers

nbme22/Block 1/Question#1 (reveal difficulty score)
A 66-year-old man develops worsening ...
Dilution of serum sodium due to ADH (vasopressin) secretion 🔍 / 📺 / 🌳 / 📖
tags: RAAS

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 +23  upvote downvote
submitted by ∗imgdoc(183)
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I itkhn lato fo lpoeep imhtg hvea erov mpiashzeed who ntrpoatmi NPA dan BNP ylreal rae, yse ti si irptomtan to kwno sehte etiepsdp get ertedesc by eth aatrilvtacilreunr/ ramdcomyui drigun rahte .lieaurf wHeoerv itehr oaelvrl nestsieefcvef in etatinrg arhet elrufai is i,hzcl a etpepcorr otdl me taht fi APN nad BNP were os useulf ni eatisrurins ehnt hyw od we vieg ur?iesicdt stI' bcuesae SAAR vrrsowepoe thsi ssmtey chnee gicauns avigntee fsteecf and eht dsenels lopo of herat lf.ireua AKA wyh ew ivge CAE orbih.intsi

Knwogin ahtt ANP sget eidnuretzal by the AASR ests,ym ew acn shitf ruo cusfo kacb to rtahe reauifl ni this nt,etpia eherw riacacd puuott is earesdd,ec ienldga ot AHD rcioesent nda naflyli idlitluoan imapnayr.ohte

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almondbreeze  a ocepcnt lytnonucsuoi zapiedsemh yb u,w ubt I gte sayawl nwrgo '(: +4
almondbreeze  oogd kowr nod!e +1
raffff  hwy soed the boyd maek pan at lla cnesi sit os esseuls +4
makinallkindzofgainz  afr@fff - ta seatl NBP vgies us a good kremar orf thera liuaref aiaxoresbncet ): taknsh dyo!b +1
mannan  aYeh 'sit tonapmrti niciylcall ceabuse it hsa a hihg iyeisistvnt i(f evintage, erul u)to orf earHt a.ifuelr +1
alimd  At eht smae time ANP bistinih rnine ?ealseer +1
freemanpeng  If it si iHgh RA,AS lAdo msut be Hhgi as eg(nIIAllw cnuedi lodA reom nath H)A.D Tnhe atht ldwou eb -RLSEWATTA rniteonet etrhar naht REUP AETRW ne.rietnto ON mriayetaohnp +
plaguedbyspleen  hisT ptnitea is irhaispdct-ng nad tefrereho sha lwo efeifcvte galruticinc l.meuvo I ilke to nikht htat egniv ihs CV iot,hysr eh si ryboblpa no na ECA iitobinrh ro ominstehg .srmiali So thta vlaees AHD to od ist n.tgih Alos hgih roodaestlne sivgna satl itsn' omthsgeni ew nede to dneircos venig eht mtse dna nraswe oc.hceis +



 +12  upvote downvote
submitted by ∗meningitis(644)
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I olas gouhtht het msae as b,uel@sbb btu won tnyrig to su"i"jfty sith trkcyi MNEB :uoeisqnt I tnikh this lveresov no het tafc taht eth ptaniet has a GHHI obdlo sserreup mneaing ew ohduls fucso no na ernswa atth paenislx tohb renacesid PB and Hoapleimoyv i(.:e daesecrni ADH hhcwi itsroaocvsntcs nad loas brssaob af-twr,eree othb fo hichw eeicsarn BP dna aeucs ayplvo.mioe)h

ayMeb if hist nipetat wree pesemddtacneo ihtw WLO ,BP eno ducol kinht rmoe buota N.AP

I sltil khnti tshi inqetosu si OTO crtkyi.

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meningitis  or,rSy eniotyama*rhp r?ihtg +1
mantarayray  I iktnh atht ti's ont APN bsceeua PAN lilw seuac a slso of Na tub teawr lwil lofwlo t(hye yalsluu go ,rhe)otetg srewhae DHA liwl ueasc onotrsapbi of olyn waetr dna lwil uceas enathmoypiar cxee tp noyl ghttouh tsih stpo gtnetgi teh nuoitesq wgrno "): +5
mantarayray  pOos sorry hte afrgotmtni si no:nfcsugi I tkhni atth ti's otn ANP becaseu NPA lilw csaue a slso of Na but eatrw lwli foollw heyt( alyusul og rt,)hgtoee aereshw AHD iwll cesau ipabootnrs fo ylon rwaet and liwl acuse oiayrnt.mehap +4
pg32  arty@maan tyerpt srue uoy ear thigr nad hatt is teh onyl yaw to tge hits ntuoieqs c.trceor eibmrgenmeR tath aN tncotrcaionen aelyrl si a earemus fo teraw eaabncl si y.ke fI het tp is otapmi,chnyer atth stju seamn yeht haev oto cumh ertaw ni het l,bodo whhic is deucsa by .ADH fI eth tntiape saw oMLCEIhpy,OV ttha thigm amen thye ear gsnloi oto humc N.a h Tsi si turldieatls by pts twhi SIHDA. heTy ear iohratpm,nyce but viee,ulomc iegnnam ahtt eyth veha oot umch ewrta (apheratonmiy ormf eht DAH) utb erthi aN abnlcea si ko eud( ot etexirnco of Na via NPN)B/AP +1
avocadotoast  We need ot be ihgktnin butoa who terah eafirul is a iitodnonc itwh a olw tevcifefe triauclcnig e.olvum Oru nteptai dah an IM dna nwo ihs aetrh tcan peke up tihw eht vmueol lwo( )O,C elganid to n.tnooscieg nWeh nscntogieo cs,ocru rweta is sepudh tnoi eht nrtltsiteiai pasesc and 'nsit cgcuitilnar in the alearrit e.tmssy For htat a,orsne eth body smpar pu het ASAR dan DAH eitpsed an actula esrenica ni dboy ar.twe iThs si a imnnto-soco laseree of H.DA tA isht ipotn pmasla smodiu lelevs era dmdetnieer yb aeivterl aetnki dan elosss nda tpanemoiarhy is moocmn in heset ispentat sabeuce fo t.tha sAol, NAP dan PBN dnot' hodl a nlcdea ot the RAS.A +1



 +5  upvote downvote
submitted by ∗nwinkelmann(366)
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rmFo DtT:poUae HGTSSAPEOEIN

Liek smto rtoeh uessca of y,amtenhoriap arthe lufeira irispma eht aiyiltb ot xecrete iegsndet traew by egcnriasin raciiietntud menoohr sellev. neWh cdacria otuutp nda sysicmet bldoo upessrer rea ed,udecr voeyc"omh"ipl ,ehornsom uchs as enirn w(ith a nbsquuetes iracnees ni snoinitgane II ,r)iftooman iideaurttnci mnrohoe H(D,)A adn pripheinroene,n dnporse ]13[.- Ahulthgo maeeutdso spaitnte twih raeht iurlafe vhea esecdiran aslapm dna rarauxleellct fdlui osuvl,em eht oybd ereeipscv omvleu peintedlo ce(rdude etveiecff aarritle oldob olevu)m esicn eht wol ccardai ouuptt deaesresc eth eusprrse gnipreusf the rcaoeotrpesrb in the coradti isuns dan eht earnl naeffetr . aroTliheeret geeedr fo mharuuoelorn anitoatcvi si agleelnry tdarele ot hte yvseteri of crciada tnoiydncfu,s sa sedaesss yb tlef ectvrualnri entjeioc inofract ro inanfolctu saslc [2]. hTe nrlheaomoruu hagencs limit tbho dosium dna aerwt xcteireon in na mteaptt to terunr foupierns preusers ot a.olnrm HAD elearse cyltedri nhesnace arwte noitrebpasor ni eht nglecltcoi uebults, wesahre goesnnintia II adn hoeniernpenpri tliim ltaids watre eeidvryl (nad rebehyt etrwa toecex)irn yb ilewrngo het murolaelrg iftioalrnt rate deu( ot a rdkaem cndetoiru in rneal f)prsneiou adn yb naiinegscr ximaplro ouidsm adn reatw enpibortorsa [.4] nI tdndia,io tboh the wol accirad uuotpt dna ihgh onasiienntg II evesll are tntpeo tuslimi to t,rihst gelndia to cedhnena erwat eak.nti

fn/ua2l-sowmetwenpmoptnn-thit/ht.stpa:otei#iuyt-/c/a-arrttwpHahtheirdweoe-cin.as

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 +3  upvote downvote
submitted by ∗bubbles(79)
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shiT eunsqtoi oeusnfdc em a otl ecsaube so naym ntessuioq avhe rddlile em no het pcotaemnir of hte PNA cseaep maehmcsni ni teims of ludfi lrooadev as( ni CH.)F

I gthtouh NAP asw a uegh plyaer ni het lsso of Na in sutrcnmccsiae of moevul oderlvoa as in tshi ptiaetn hciwh( si hwy ouy ese omeveucil thayerOminpa ni aitestnp iwth SIHAD or evoviicttyar of hte SRAA sa ni )FCH.

hWy is DHA own eibgn anmed sa eth lobispserne gtn?ae

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jooceman739  yM innikthg si taht NAP cseuas srsiueian,rt os ou'ery gilsno astl nad wreta at teh sema iemt (oiimsostoc lduf)?.i ,einhewaMl DAH baorssb nyol eefr etw,ar so ti udowl iltdue eth mcsr .trr oC eeu em fi 'im n.wrog +13
bubbles  hhOh uoy rea gthir. anhTk ouy for het neaipaonltx! I ogt so tedxiaf no atht neo chmnsmaie .haah +4



 +2  upvote downvote
submitted by ∗dr.xx(176)
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HFC isaptent enoft dyalisp ngiss and yspotsmm of nrsidaeec eaprnssvsio eriestocn.

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hyperfukus  if lla eels silaf i epho i utsj lidlr ihst eon naetstmte in ym abrni adn it ecsom tuo ni het irhtg way on ttes ayd ntakh !!u! +1



 +2  upvote downvote
submitted by ∗drmohandes(193)
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reeH we og:

  • daeescdre VL rtcytoiclnati l(tierbala csecal)kr
  • cddeserae daciarc uuttop
  • vcaeatti ASRA → AHD
  • naeiesrc thmapeysitc avttiyic → rmeo RASA → eorm HAD
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 +1  upvote downvote
submitted by ∗moloko270(77)
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b.mpn/ve/sp0u2h/7i.mhc5tdoi8w.8tn/:w.lnwbg2

"yosndemr of ilit"unaold ya"lhoo-yopimlts in veeser otecgnevsi rehat iruefal amy be udecas by na narrplioptepyai hghi HDA eiescntro ni wichh teh opocsrmeeort teyssm si oinemaddt by mlsoronnao mtulsii"

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hayayah  erynlap,tAp ni incohrc FCH uyo ese hae.rytinmpoa cueBase CHF ssucae a eascedre ni ciadrac utpout adn irgncautcil olbod l,vmoeu wchhi ni utnr rtgisgre a eapromsnocyt psnrsoee adiem at prgsnereiv obold ruperess. hTis stetlaiums eth yodb to netira obth rwtae dan io.musd +10
seagull  i raege htiw ..ay.yhaaH eth AASR ssyemt is tteaviacd edu ot poro orsepnfui ot teh denyki due ot dcmope ahrte .arlifue +6



 +0  upvote downvote
submitted by nicsar(1)
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apHotreymain form aeituHareflr .tp

It lshduo eb parcohepad rmfo Htear ai.rufe

&F-;Hgt ARAs g&t;- exsesecvi st,Anooedelr DH;A PNA paesce iaefu,r lkie asrodycen sirnrmodsleatp;oehy miretapyHnoa

ul6hW:wg02mh-8/9c7ltt9C/-1o/imw541/1/.34e.wv.s-5jp/t0Jwgtf/n-9

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 +0  upvote downvote
submitted by ∗dubywow(23)
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eoesdaentmDpc FH. Lkac of loobd lowf ued to iainflg htrae gt;-& elorw BP ;g-t& anciedrse HDA ot naecrise bdolo rseusrpe kabc to ltesba lev.el In D,FH DAH paoteusc iasshometos of ocnurtaiengtc PAN &pma; PNB. Thus, eht mtre pndsd".tomceeae" Aioscdesat iwth tssoensrh fo erah,tb edame o(neft of su.)gln

hsiT osivuci lceyc tsncieuon sa odyb otiieziprrs aqeetdua PB orf livv,uras but ti coems ta hte esnexpe of oweerdorkv rteha tath stmu rkow arrdhe dna r,erdha etmaituyll rcntebaigeax eht thare lfiauer dotni.coni

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 +0  upvote downvote
submitted by ∗asharm10(37)
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lysAwa nwok isht opyH or mapnyartrhiee si uebecas of ngaech ni eth ulvm,eo tihs ineptta is gngoi ghthoru rehat la,ueirf lerna upeoirnsf hsa gneo nowd atth slead to elsreae fo DHA sco of etecoooprsrsm .msiuoaltitn Nwo hghi DHA illw aoerbrbs mreo eefr waert tath lilw adle ot ahmyn.repiato oS rihopyntemaa si somtal lawsay deltaer to gihh .DAH I know few fo ouy wlli tihnk but AASR setysm si tcatdvaie too btu hatt abbors Na nalog iwth twear utb AHD stju free r.atwe

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 +0  upvote downvote
submitted by ∗hello(429)
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erThe sah to eb a tebtre tpeoiaannxl orf hwy ANP is nrgw?o

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waterloo  fI hits tsp' PBN/NPA reew suincag imh to moebec yn,apmrhtcioe hwy oeds he ahev diufl evlorado ypsmotsm artaei(bll ckcsera,l ,DVJ ihhg ?PB) e Tehr ash ot eb ihsogntme eels oviomengrc the NPA yetssm. +1



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submitted by ∗happysingh(57)
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i knida of flee o"dd" akgsni stih itusnoqe : btu the taetnip had na IM 6 hotsnm oa,g os hyw lwdou it be yllkeuin thta he saw tdol to "icrtsetr stl,a esricrtt fdsilu (rawet) " ??

suGse tawh mi' ikgasn si : waht kmaes ciecho E ucsh na eylnkuli hoecic (V,JD babsi-ailr rakecs,lc heeapirlpr dmaee) ?

p;&ma miingn@tise : sih pb is 3821/5 Hgmm ... hwy si hatt HGI"H" ??

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 +0  upvote downvote
submitted by ∗freemanpeng(7)
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tyFli,rs I oshce .AHD eWnh I thtoghu etiwc in riee,wv I kdicep sesdocr DHA dna kcdepi yNAP M. oilcg to scros .HD :A1 Teh naim uceinrd of DAH rea Oms nad o/emBluPv. siHT ,pt msO ouoysvilb nto ih,hg Bp oovbsulyi not ow.l So, sonsnene ni idernasec DH.2A uY.o aym see InAgI also dcesiun DHA. Btu it smees ot be a orinm cdiure.n ,weleanMih fi it si tyexcla hhgi gII→nA ghhi DHA. eTh,n oAld tusm be ihhg as wl,el dna igHh ldAo Sal→t eirsnprg→ve WOH NCA uersm Suomdi be O L?w"LoW daircCa tu→tupo Hgih SASR AIIgn( olAd DH"A) hatypwa si OAMUW-TIDSER een.ritont NOT prue ATERW taeinretsen oleP etrcroc me

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