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nbme23/Block 4/Question#28 (reveal difficulty score)
An 18-month-old girl is brought to the ...
Decreased sodium bicarbonate reabsorption in the proximal tubule 🔍 / 📺 / 🌳
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 +36 
submitted by step420(34),
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eutosniQ tryept cmuh is skangi awth ytep fo usriv si eessa,lM hihcw is a vtgeaeiN AssNR si.vur


 +27 
submitted by seagull(1794),
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Tsih is a etpy II Rlnae rlabTuu o.idscAis My cidlMae lhocSo Nreve tghuat this to em. iDd uoy laos og ot vypeotr edm ohcs?lo 'mI urdesprsi heyt veen eavg us teilto ea.rpp

mousie  haha mine didn't either. But they usually leave out most high yield info so, to be expected I guess. +11  
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 +5  

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

+2/- apurva(94),


 +20 
submitted by smc213(160),
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To be elopcmlyet !caelr

shiT entitap hsa oyisCtissn a erar aumlsaoto ercseevsi aoslolmsy oterags sridredo dan sotm moomcn saecu fo Fncoina dymosrne in .rhelicnd sosisitCyn is msytisec adn leads ot esiytnc ractlsy spdteosi ni llesc dna essitsu orohuttugh het yb.od

uhgohAtl lsoWnsi esisade nca leda to ,FS teh yrlcssta in het nresoca dsoe nto ratreoecl thwi isnlWso daeis.se
e Mro nf:io rhvwlctb8psao//twci/ipg.1/nmlC0t4.e4..m1:/hsMin6cwnP/

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. +3  
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  



 +6 
submitted by lamhtu(135),
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To be nvee ,lrceaer sthi soudns eikl niconaF eosr,dmny ichhw sha aeld ot Tepy II TAR




 +3 
submitted by nor16(68),
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stju know erehw teh gib tsffu / ttnmopira futsf is d,roeebrs it is eht T.PC No eedn ot okwn sTAR erh.e..




 +3 
submitted by sympathetikey(1535),
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yesK erwe t:eh

oia-csuGlru

-opruiaashthP

A-onim cdariuai

hoseT usoldh be absobderre- by teh CPT, so if 'eeyrth on,t yTpe 2 A.TR

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. +  



 +1 
submitted by asharm10(36),
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hptPesoha si dnow ahtt msean ignhmsote is nrogw htwi CTP, thne onn onnai gap siocsadi that anmse bnatiareboc si ont bigen odbasb,er surocuilag iagan PCT so stju eus rouy riabn dan oechso cadseeer ebcaiorbtan iabtseoorprn in PCT




 +0 
submitted by agraham416(3),
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I ntd'o khnti oyu enev adh ot know waht sidasee sthi ,wsa ubcesae I .itndd' I teonicd tath het dik swa nslgoi a lto fo ginhts ni hte unire, so 'hretes bayprblo tgonhmeis wgnro twih the nikey.d neO fo teh anim unconftis of het idneky is to reiteh esbbrrao cbbari dna esicn ehs hsa a mrpelbo gsrnebiabor a otl fo htore u,ftsf I tsju rfidgue lakc of bbcrai ponseboirrat eadm eth omst .sesen




 +0 
submitted by titanesxvi(100),
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hyw tno easceedr CA yivitcta in the amprilox ?butule tihs osal cuold lead ot eiotalbcm siasoidc.

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. +  



 +0 
submitted by yb_26(296),
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loinWs idesase ;=t&g nicFano nsroedym &=t;g clmeoibta ioaisdsc pt(ey II r)xli(mopa T)AR




 +0 
submitted by charcot_bouchard(519),
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A esac of cFaonni nmeds.ryo fI it swa odtisela pyTe 2 TRA tooinp B ouwdl eb the wesn.ra




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