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NBME 24 Answers

nbme24/Block 2/Question#44 (reveal difficulty score)
A 35-year-old man with quadriplegia develops ...
Area labeled โ€˜Bโ€™ (Proximal convoluted tubule) ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +10  upvote downvote
submitted by โˆ—neonem(629)
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Aminoglycosides are nephrotoxic; nephrotoxic chemicals/drugs cause acute tubular necrosis (ATN), characterized by damage to the PCT. ATN causes the formation of brown, muddy, granular casts in the urine. The fact that this patient is a quadriplegic might be suggesting that they have a lower volume of distribution for the drug (and therefore higher blood concentrations).

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mtkilimanjaro  I would also like to add ATN is nephrotoxic ischemia and the two places in the tubule that are susceptible are the PCT (proximal straight part) and the thick ascending limb. The TAL is not labeled as a choice so that is why it has to be B (and why B is a little further down from the convoluted part) +4
mtkilimanjaro  Actually aminoglycosides might only affect the PCT idk :( +2
peridot  on p. 591 of FA 2019, it talks about ATN. The two types are 1. ischemic - affects PCT and thick ascending limb because those two areas use ATP the most (think of all the ion pumps) and 2. nephrotoxic - PCT only (I think of it as that's the first part, so it's most exposed to toxins). Aminoglycosides fall under scenario 2. +3
cassdawg  If you wanna see nephrotoxic drugs in one place, here's an image with the locations of different nephrotoxic drugs: https://media.springernature.com/lw685/springer-static/image/art%3A10.1038%2Fs41581-018-0003-9/MediaObjects/41581_2018_3_Fig1_HTML.jpg +3
corndog  Before anyone looks at @cassdawg link, consider taking some Loperamide. +6
weirdmed51  @cassdawg do you want us to be admitted in asylum before sitting for the exam? +1



 +4  upvote downvote
submitted by procrastinator(9)
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This picture is horrible. I thought B was the proximal straight tube making me feel really dumb

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 +3  upvote downvote
submitted by โˆ—andro(269)
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ATN ( Acute Tubular necrosis ) may be either ischemic or nephrotoxic:

  • Ischemic - tends to affect the Proximal straight segment PST and the TAL ( thick ascending limb)

*Toxic - tends to affect the PCT ( convoluted segment )

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peridot  this is on p.591 of FA 2019 for anyone interested +1



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