need help with your account or subscription? click here to email us (or see the contact page)
join telegramNEW! discord
jump to exam page:
search for anything ⋅ score predictor (โ€œpredict me!โ€)

NBME 23 Answers

nbme23/Block 3/Question#45 (reveal difficulty score)
A 44-year-old woman comes to the physician ...
Decreased arterial Pco2 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags:

 Login (or register) to see more


 +9  upvote downvote
submitted by โˆ—seagull(1933)
get full access to all contentpick a username

This is a panic attack. Hyperventilation drops pCO2 leading to a respiratory alkalosis. po2 is relatively unaffected (don't ask me how?)

get full access to all contentpick a username
sympathetikey  Yeah haha I had the same conundrum. +
sajaqua1  If she's breathing deep as she breathes fast, then oxygen is still reaching the alveoli , so arterial pO2 would not be effected. +27
imnotarobotbut  lmao i'm so freaking dumb i thought she was having alcohol withdrawals because it was relieved by alcohol +2
soph  Maybe Po2 is unaffected bc its perfusion (blood) limited not difusion limited (under normal circumstances). +2
charcot_bouchard  PErioral tingling- due to transient hypocalcemia induced by resp alkalosis. +2
rainlad  I believe CO2 diffuses ~20x faster than O2, so increases in her respiratory rate have more effect on her PCO2 than her PO2 +3
usmile1  adding onto Charcot_bouchards comment, I found this: Respiratory alkalosis secondary to hyperventilation is probably the most common cause of acute ionised hypocalcaemia. Binding between calcium and protein is enhanced when serum pH increases, resulting in decreased ionised calcium. Respiratory alkalosis can induce secondary hypocalcaemia that may cause cardiac arrhythmias, conduction abnormalities and various somatic symptoms such as paraesthesia, PErioral numbness, hyperreflexia, convulsive disorders, muscle spasm and tetany. https://www.sciencedirect.com/science/article/pii/S1110184913000615 +4
fatboyslim  Wow very cool. I didn't know alkalosis causes hypocalcemia or why hyperventilation causes perioral tingling. I thought the tingling sensation was due to hypocapnia-induced cerebral vasoconstriction and hence decreased cerebral perfusion. Sort of like when u get choked out you feel tingling (not recommended lol) +1
ankigravity  H+ can displace Ca bound to albumin. So, โ†‘ H+ (acidosis; โ†“ pH) โ†’ โ†“ Ca binding to albumin โ†’ HYPERcalcemia. In contrast, โ†“ H+ (alkalosis; โ†‘ pH) โ†’ โ†‘ sites available for albumin to bind โ†’ โ†“ Ca (hypocalcemia) +



Must-See Comments from nbme23

ferrero on Precapillary resistance
yotsubato on 99%
sne on Triglyceride
sajaqua1 on Area labeled โ€˜Dโ€™ (Spinothalamic tract, right)
stinkysulfaeggs on Hypoglycemia
hayayah on Iris
soph on Peak inspiratory pressure (alveolar): ...
seagull on Area labeled โ€˜Cโ€™ (Cranial nerve 8: ...
water on Dietary change
wired-in on 28.8
beeip on Binding of permeable ligand to nuclear ...
thomasalterman on Hypoglycemia
yotsubato on Inhibition of the cytochrome P450-dependent ...
seagull on Decreased sodium bicarbonate reabsorption in ...

search for anything NEW!