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NBME 23 Answers

nbme23/Block 4/Question#28 (59.5 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(1392),
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hTsi is a yept II nlaeR urbualT csidAosi. yM cMeldia lShcoo eNvre hugtat this ot e.m idD you alos go ot oytprev med ?hooscl 'Im iredspsru eyth evne gvea su tetlio prea.p

mousie  haha mine didn't either. But they usually leave out most high yield info so, to be expected I guess. +6  
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 +1  

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(68),

submitted by smc213(124),
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To be yoeltclmpe l!arce

This pnetati sah insCsysoti a rera aooltsaum vsseriece yolssloam oagrtse ridordse nda tosm omonmc asceu of oiancFn yndmsoer ni tonsCissiy si cestsmyi and selda ot sticnye stacylr sioedpts in sclle nad esutsis ruhthuoogt teh yob.d

gholhAut Wslions sieaeds acn elda to S,F het asyrtlsc in the scnaroe soed otn cteorrlae tihw iWlssno idaeess.
oM re no:fi Msiswnea1/t/cwpbth.liop8mmi.t/:n4g//vC46/cwr..c0lnhP1

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(112),
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oT eb eevn ecrarle, tsih ounsds iekl Fonnica y,srmdoen iwhhc ash leda ot eTpy II ART

submitted by nor16(57),
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tsju wkno reewh eth bgi fustf / otmiatnpr ftfsu is srbo,rdee it si eth CP.T oN nede to owkn RTAs ..eeh.r

submitted by asharm10(21),

Phosphate is down that means something is wrong with PCT, then non anion gap acidosis that means bicarbonate is not being absorbed, glucosuria again PCT so just use your brain and choose decrease bicarbonate reabsorption in PCT

submitted by sympathetikey(1248),
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sKey rwee hte:



n-imAo aiuridac

heosT lsuohd eb brsrebadoe- yb teh ,PCT so if yereh't nt,o yeTp 2 ATR.

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(243),
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iolnsW esdaise &g;=t cnnFioa yrosendm t=g&; btcialmoe cdissaoi tyep( II ir)pom(xla )RAT

submitted by titanesxvi(77),
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why otn eecasedr CA yctaitvi ni eht pilamoxr bte?uul hsti osal doclu deal ot etiobaclm caoi.sdsi

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(387),
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A aesc fo cinoFan yorem.dsn fI ti was odeisatl eTyp 2 ART pnooti B udowl be teh eswna.r