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NBME 20 Answers

nbme20/Block 4/Question#20 (41.9 difficulty score)
A 5-year-old boy is brought to the physician ...

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submitted by imgdoc(132),
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uYo acn soscr tuo hte top etrhe ansrwe oihcesc, B.,,CA Yuo wotn be oesnigbrrab hninytga ni the PCT in nncaisof' dory.emsn oginkLo ta aap,mhilkeyo iomrhp,anytae nda opsipahoypeathmh .wno amlHyepakio c'tna be rrctcoe ebecsua evne htouhg iamtoupss is lsot it will be raoresebbd at hte lraet hctik casdiegnn loop dna if ttha toesdn emka esns,e hte yobd lwli dujsat for owl rsume mistapsou tub ctvitagina het ++/HK uppm on lcle.s tI sn'it mrteahnpyiao ausbece ta hte enlociglct dtcu cairplnip lls,ce eoasbnopirtr illw ocur.c Tihs vlease omstaoppaphhhiye as eth roectcr nad ylno sreawn hcieo.c

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(78),
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hiTs dosnus klie coniaFn rn.omdesy The ioplxarm uaubltr pelaihliet selcl heva a rahd etmi norrbgbaise a,ertltif os lly'uo ese a osls of shptop,hae nioma dsc,ia oearcbn,iabt and sl.gueco

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? +  

submitted by mdmikek89(0),

Y'all over complicate this shit so hard. Whether or not its Fanconi, it says Proximal Tubule defect. 85% of phosphate is reabsorbed here. If its defective, phosphate re-absorption is decreased.


meddoc2023  Yes and sodium absorption would be affected too I believe because the PCT is affected +