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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 step420(34),
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ioQsenut tyetpr uhmc si kngisa wath ptye of uirsv is l,saMese wihch si a gtNaieev AsNsR .vsiru

submitted by seagull(1755),
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Tsih si a epty II lneaR ulaurTb cAsiois.d My iMcdela lohcoS evNer ugttah sthi ot .em diD you sloa go to vrtopey dem olsh?oc Im' epudirsrs ehyt enev gvea us oitlet .prpea

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 +4  

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(88),

submitted by smc213(158),
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oT eb ecopelmtyl !acler

hTsi aitetpn ahs syossiitCn a rera osutamalo ervesseci yolssoaml groetsa dorsdier dna msot mocnmo ceuas fo nnFciao odseymnr ni clrn.hdei nyssiistCo is stysmeci nad lsdea ot tisecny syactlr oietspsd ni llecs nad ssietsu gouotruhht teh yobd.

thuohAlg ssilWon siseade cna adle to S,F hte tcysslra ni teh rasocne sedo otn lreaocter tiwh onlssWi essaei.d
eoM r :onfi ww:lcbnwp4hcisn1/gr/iam.Cs0.i.4/tM1o/tlhP6p8vcn/.mte/

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(133),
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To eb vnee cerr,ael tsih dnsuso ikle cFnioan o,yemdrsn chhwi ash deal ot pyTe II ATR

submitted by nor16(67),
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sujt kown whree the gbi tusff / nomrttpai ustff si ,rorbsdee ti si teh T.CP No deen ot knwo RTAs

submitted by sympathetikey(1508),
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seyK ewer teh:



mAin-o riadcaui

soTeh lsouhd be rb-erosbaed by eht TPC, os fi he'tery o,tn peyT 2 RT.A

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 asharm10(32),
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ohtshPeap is wdon htat amsne hnitsemgo is ongrw ithw ,CPT hnte nno annoi agp iocidsas tath manes aienbtabrco is nto nbige e,asdbobr gisucoular iaang PTC so utjs esu ryuo bnira adn oceohs sdecraee oaebintabrc tsroioanebrp in TPC

submitted by agraham416(3),

I don't think you even had to know what disease this was, because I didn't. I noticed that the kid was losing a lot of things in the urine, so there's probably something wrong with the kidney. One of the main functions of the kidney is to either reabsorb bicarb and since she has a problem reabsorbing a lot of other stuff, I just figured lack of bicarb reabsorption made the most sense.

submitted by titanesxvi(98),
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ywh nto srdeceae AC ayiivttc ni het romiaxlp bltue?u shti asol duolc dlea ot aotciembl .asocdsii

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 yb_26(287),
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slionW eseaisd ;=> Fconnai rsdenymo ;tg=& cmlaieobt cisisdoa y(ept II lopa)mrix( )RAT

submitted by charcot_bouchard(507),
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A cesa fo nncFaio mdo.esnry If it swa itsloead eTyp 2 ATR opntio B oluwd eb eht aew.srn

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