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NBME 20 Answers

nbme20/Block 4/Question#20 (44.3 difficulty score)
A 5-year-old boy is brought to the physician ...

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submitted by imgdoc(135),
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imgdoc  by* +2  
larascon  Excellent explanation, thank you ! +1  
waterloo  It's worth mentioning, that 25% of Na is reabs in the thicc ascending limb. 67% of filtered Na is reabsorbed in the PCT, whereas 85% of phosphate reabsorbed in the PCT. So pt more likely to show Hypophos. +  
coconut  UWorld QID:7626 says lab results in people with Fanconi syndrome will show hypokalemia +  
j44n  coconut i thought that too but then i remebred fanconi is associated with hypophosphatemic rickets/ VIT D resistant rickets and this little dude is going to be growing because he's 5 and thats gonna increase the demand for phosphate in his body +  

submitted by celeste(83),
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hsTi sunods ilek inFnaco .nemodysr The xlroiapm balutru haetliepli lescl heva a ahdr mtie rrnbbeoasgi rtfleia,t so u'olly see a osls fo tshoahe,pp aiomn isdca, noearbi,cbat and .olgscue

medschul  Wouldn't Fanconi syndrome also cause hypokalemia though? +4  
yotsubato  Especially considering the fact that the DCT will be working in overdrive to compensate for lost solutes??? +1  
nala_ula  This question did not make sense to me at all. I knew it was Fanconi syndrome yet didn't select the obvious answer because it said "follow up examination 1 week after diagnosis". I thought it would already be in treatment... I searched (now) and it says that treatment is basically replenishing was is lost in the urine. So definitely the wording is like wtf to me +1  
sugaplum  I was thinking since it affected the PCT that Na resorption would be affected as well? But I guess the other segments will pick up the slack? +