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NBME 23 Answers

nbme23/Block 4/Question#28 (60.1 difficulty score)
An 18-month-old girl is brought to the ...
Decreased sodium bicarbonate reabsorption in the proximal tubule🔍

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submitted by seagull(1443),
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isTh si a etpy II Rlane uaTublr dicsAois. My aeilcdM hlooSc vrNee tghuat thsi to .me idD yuo saol og to yertopv emd lo?hcso 'Im dsruipser hyet eenv aegv us lteito paper.

mousie  haha mine didn't either. But they usually leave out most high yield info so, to be expected I guess. +6  
yotsubato  I didnt have physiology in my medical school. None, zip, zero, none. Nor did I have biochem. They said "you learned all this shit in undergrad, youll memorize it again for step 1 and forget it promptly" and then just moved on. +9  
jcmed  In the Caribbean thats 1 thing we were given... lots and lots of toilet paper +1  

For those who are wondering why not decreased H+ secretion = H+ is just looping back and forth to make H2Co3, only HCO3- is absorbed

+1/- apurva(68),

submitted by smc213(127),
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To eb ypeltlocem !ecrla

ihTs epitnta has toinsCisys a erar oaamsluot receessiv sllymsooa earsgto isroedrd adn otms comnom scuae of naioFnc edrynoms ni hr.indelc ssiCtoyisn si ismcseyt dna adlse ot snyctie catrlys isodtsep in clsel nda sietsus hgotrthouu the ydb.o

oghthAul nosliWs esiades cna leda to SF, het ayrlstcs ni eht asreocn soed ton cleoatrer twih lsWoisn e.sedasi
o Mer o:inf tw8/bneiw:g6.4im/nPhwrlip1/pnalcm.ct.4M0hCss///1tco.v

highyieldboardswards  Thank you! You are a legend for figuring this out! +  
paulkarr  Appreciate you. +  
drzed  And even if it was Wilson disease, it would have the exact same consequence leading to Fanconi syndrome. +2  
abhishek021196  Fanconi syndrome Generalized reabsorption defect in PCT = Increased excretion of amino acids, glucose, HCO 3 – , and PO 4 3– , and all substances reabsorbed by the PCT May lead to metabolic acidosis (proximal RTA), hypophosphatemia, osteopenia Hereditary defects (eg, Wilson disease, tyrosinemia, glycogen storage disease), ischemia, multiple myeloma, nephrotoxins/drugs (eg, ifosfamide, cisplatin), lead poisoning. Polyuria, renal tubular acidosis type II, growth failure, electrolyte imbalances, hypophosphatemic rickets = Fanconi syndrome (multiple combined dysfunction of the proximal convoluted tubule). +1  

submitted by lamhtu(113),
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To eb vene lre,earc htis dunsso elki cnonFai mdr,syeon hciwh has ldae ot eTpy II RAT

submitted by nor16(57),
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tujs nokw rewhe hte big sftuf / onmttarpi ftsuf is dee,brrso it si hte .CPT oN deen ot know ATsR ..e.reh

submitted by asharm10(22),

Phosphate is down that means something is wrong with PCT, then non anion gap acidosis that means bicarbonate is not being absorbed, glucosuria again PCT so just use your brain and choose decrease bicarbonate reabsorption in PCT

submitted by sympathetikey(1265),
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syeK wree hte:



nm-oAi icriaadu

oTshe lshduo be e-oedrbrbsa yb the PT,C os fi 'etheyr ton, ypeT 2 R.TA

lamhtu  To be even clearer, this sounds like **Fanconi syndrome, which has lead to Type II RTA** +12  
yb_26  To be even clearer: Wilson disease => Fanconi syndrome => type II (proximal) RTA +  
charcot_bouchard  To be even clearer, you all have been pretty clear +  
charcot_bouchard  To be even clearer, you all have been pretty clear +  
yng  I don't thin this is Wilson (copper in descemet layer of cornea). This is cystinosis (crystal in the cornea) --> Fanconi Syndrome --> Type II (PCT) RTA. +  

submitted by yb_26(248),
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Wsloni sdesaei t&;g= anicoFn osednymr g;&=t btclmeaio iscidsao (teyp II al(rm)xipo TA)R

submitted by titanesxvi(78),
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wyh otn easceedr CA tvayciit ni eth mpiolrax tbeuu?l stih aslo locud dela to tcmiboael oics.dsai

ergogenic22  carbonic anhydrase inhibitors can cause Type 2 RTA but it is not the cause here (cystinosis) +  
doublethinker  Yeah, I said CA too. Problem is that CA deficiency wouldn't lead to lack of reabsorption of all the ions listed. +  

submitted by charcot_bouchard(391),
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A esac of ncinaoF n.eoydsmr fI ti was etlidoas pTye 2 ATR noitop B wluod be the .easnrw