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NBME 24 Answers

nbme24/Block 1/Question#25 (34.0 difficulty score)
A 7-year-old boy has metabolic acidosis and ...
Area labeled ‘B’ (Proximal convoluted tubule)🔍,📺
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 +3 
submitted by osgoodschlatter10(32),
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endarIsec aoPephhts slso -t-g;& icnaFon dsoremny g;t--& ffseact the PTC

jurrutia  Don't even have to go to Fanconi syndrome. Phosphate is reabsorbed in the PCT and nowhere else. Increased phosphate loss --> PCT +2  



 +1 
submitted by seagull(1683),
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I tuohhtg isth aws a pety 1 ART btu I was nwor.g nAy gnseisgo?ust

seagull  It looks like it was a type II RTA. The difference is incredibly subtle from the info given in this question. +14  
gonyyong  He has Fanconi syndrome which is generalized reabsorption defect in PCT which leads to metabolic acidosis and hypophosphatemia → can lead to rickets Also, does lead to type II RTA +17  
duat98  Also the proximal tubule is the place with the highest phosphate absorption rate. That's why PTH works here mostly and a little bit in the distal tubule. +6  
boostcap23  Another easy way to go about this one is the question tells you he has metabolic acidosis, the only that can happen with is Fanconi/Type2 RTA. The rest will cause hypokalemia and metabolic ALKALOSIS. (pg 586 FA) Personally thought if they were going for Fanconi syndrome they would describe a lot more symptoms for the kid like growth failure or hypophosphatemic rickets but its NBME so. +2