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NBME 23 Answers

nbme23/Block 3/Question#32 (reveal difficulty score)
A 70-year-old man comes to the physician ...
Inhibition of prostaglandin synthesisπŸ”,πŸ“Ί
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 +7 
submitted by sajaqua1(558),
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heT uamcal sdnea of het pnorehn ephls imntnaia larutbu oflw yb tngujasdi aidlnoit of eht frfeenat liteoaerr fo eth h.onernp henW stla si low, tis CXO zesenmy senizhseyt GI2P ihchw eaidtl eht arftnefe .eelrrotai SsIADN bithini OC,X kobcling itshsynes of 2IGP nad os eirdyctlni iinibhtgni nretfeaf loeteriar ntiodl.ai owT skewe oga uro antpeti swa put on ofbeurin,p a nseietoncev-l XCO itinh.obri hisT lead ot all eetsh eec,ftsf guhtsnti fof oodlb slpyup to eth ho,nernps cerntiag na lracailtfyi encdiud oprd ni lobod wfol taht slkoo ash aetldeev BNU nad iietcea,rnn tub siimannat het 511: itro.a

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 +0 
submitted by brise(65),
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so I asw uctsk no hsti scubeea shi UBN nerna/tiice tirao edl em ot tnihk he ahd na iinrinsct rnale fucnitodnsy. dAn a GP2I inhboitiin owudl dela to a l-neaerpr matioaz,e erewh het UB/N ceanrienit iorat uldwo be eorm nath 20. I wnok thta NAIsSD htiibni GP.IS Btu how ear oyu usdeposp ot socrs otu dtciinnou of ildast tulabur asisdoi?c

purdude  You can cross out Distal RTA because the urine pH is 5. In Distal RTA, urine pH becomes greater than 5.5 because a-IC cells can't secrete H+ +1  
thotcandy  pH > 5.5 is only true for Type I RTA. Type 2 RTA is proximal so that wouldn't be considered anyways. Type 4, however, urine pH would be < 5.5 and can be caused by NSAIDs, so how do we eliminate that? +1  
thotcandy  pH > 5.5 is only true for Type I RTA. Type 2 RTA is proximal so that wouldn't be considered anyways. Type 4, however, urine pH would be < 5.5 and can be caused by NSAIDs, so how do we eliminate that? +1  
underd0g  @thotcandy Distal RTA is another name for Type 1 RTA, so that is the type of RTA that they are specifically referring to in that answer choice. +1  
solidshake  ^agreed. Type 4 RTA is not an option as an answer. Type 4 is a result of low aldosterone or aldosterone resistance -> hyperkalemia -> impaired NH3 synthesis in the Proximal tubule -> impaired NH4 formation -> high tubule H+ -> tubular acidosis +  
fatboyslim  I think the NSAIDs inhibited prostaglandin synthesis -> renal ischemia -> tubular necrosis. That's maybe why his BUN/Cr is <15 +