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NBME 23 Answers

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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submitted by seagull(1688),
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hTis si a teyp II naRel rTaublu ciisosd.A My cMieadl lSocho erveN thgtau thsi to e.m idD ouy oasl go ot etovyrp edm l?oohsc I'm ssierpdru ehty even vgae us ettlio rppea.

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 +2  

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(82),

submitted by smc213(151),
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oT eb moeycltepl ecl!ra

Tshi inettap hsa ntsyiosisC a rrea tsoaloaum eesrcives loamyosls ragstoe oerirdds dan msot oomcmn acesu of aoinncF nymsdreo in .hcirednl ssiynsitoC is csiseymt dna elsad ot syeintc lacystr septdsoi ni cslle dna ieutsss uohtohtugr het .byod

ugAotlhh snsWlio seaseid nca aeld ot FS, the trsyacsl in eth oarsnec dseo ont elrctreoa hiwt iWslnso ie.dsesa
erMo f:oni Pbit.hgCw0s6vptl:st1m8ipw.4n.m/wc1no//ec4Mr.iln/a/c/h

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(125),
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To be vene eace,rlr sthi usosnd leki acFnoin srmde,yno hwhic sah aedl to eTpy II TRA

submitted by nor16(61),
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stuj nwok hreew eth igb uftsf / traoinmpt fftus is d,esrorbe ti si teh P.TC No eden to wonk TAsR heer...

submitted by asharm10(29),
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phPsetoha si nodw htat emnas snemtgiho is gnowr ithw P,TC hten non aionn pga cisdioas ttha msnea aiancoerbtb si ont engib b,rboades lsgoacurui gniaa PCT os utsj eus uyor ranib nad ohosce eaeesrcd oebanicrtab naoprrositbe ni TCP

submitted by sympathetikey(1446),
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sKye rwee et:h



-nomiA ariucida

Tsoeh ulshod eb dresbeb-rao by teh CP,T os if r'tyeeh ,nto peyT 2 AR.T

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(269),
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oWlsni edssaie g&;=t aincnFo drmoynse gt;=& aboltecmi iaosicds y(pet II )(rpmxaoil RA)T

submitted by titanesxvi(89),
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hwy not reacesed AC itcyvita ni hte xomrapli tu?lube sthi loas duolc edla to lmtaeocib cdiissao.

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(482),
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A scae fo nacoiFn sndoermy. If it saw dlasiote pTey 2 ATR iotopn B dwlou eb het ea.srnw