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USMLE (United States Medical Licensing Examination) Practice Exam 20

Practice exam for USMLE (United States Medical Licensing Examination).

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Question 1 of 1000%
Time remaining120:00
Attempts allowedUnlimited
Difficulty mixE • M • H
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Question 1

MEDIUM

A 24-year-old woman comes to the clinic because of intermittent episodes of lightheadedness and tingling around her mouth for 2 months. Episodes occur during periods of intense anxiety and resolve within 15 minutes. She has no medical problems and takes no medications. Vital signs are normal. During an episode in the office, she is noted to be breathing rapidly; carpopedal spasm is elicited with a blood pressure cuff. Which of the following is the most likely acid–base change during these episodes?

Panic-associated hyperventilation decreases PaCO2, causing acute respiratory alkalosis; alkalemia increases calcium binding to albumin, lowering ionized calcium and causing paresthesias and tetany. Chronic compensation would lower bicarbonate, but episodes are brief and intermittent.

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