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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 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

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submitted by โˆ—seagull(1931)
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hiTs is a ytpe II Rlena uulbrTa soAs.idci My edcailM lSoohc erevN atugth sith ot .me dDi uoy aslo go to eyrptvo mde hc?osol I'm redusrspi eyth nvee egva us teloti e.arpp

mousie  haha mine didn't either. But they usually leave out most high yield info so, to be expected I guess. +12
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 +5

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(101)

submitted by โˆ—smc213(169)
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oT eb mpytloecel care!l

siTh ianeptt ahs tnoiCyisss a raer samoaluot irvseesce oolmsysla rogseta deorrdsi adn omst ncommo usace fo cniaFon edornyms in iche.rdln ytiosisCsn is ymecstsi and adlse ot cyeitns ractsly seodpsit in clels dna tssiues gthurhootu teh dyb.o

lhugoAth inWosls deaessi cna dlea to SF, eht trlasscy ni hte ocnaesr odse ont eaclrerto iwth sislnoW seeasi.d
reMo :oifn /Msc/1cmw6t.rt./pla1bg.swe0ihovmlni:ih.4//cnwCnP8p4t/

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. +3
abhishek021196  Fanconi syndrome Generalized reabsorption defect in PCT =ย Increasedย excretion of amino acids, glucose, HCO 3 โ€“ , and PO 4 3โ€“ , 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). +2

submitted by โˆ—lamhtu(139)
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To be enve aeerr,lc isth ndosus iekl iocanFn ,mdosnrye whhci hsa adel ot eTyp II TRA

submitted by โˆ—sympathetikey(1597)
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syeK ewer :eht



m-Anio aciiudar

seToh sohlud be ob-reebasrd by het C,PT so if eyreth' tn,o epyT 2 .RTA

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 โˆ—nor16(70)
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jstu konw ehwre teh bgi tsfuf / npairttom ftusf is e,reobsdr ti is hte P.CT oN dene ot wkon TRAs .heer..

submitted by โˆ—asharm10(37)
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taohpehsP is nwdo tath emsna tisegmohn is ronwg hitw CP,T enht nno innao agp dcoaissi ttah seamn oibrcbeatna si otn bgine ,roseadbb uouiarcgsl gaina TPC so tjsu ues uyro inbar dan sheooc seraeecd boiaceabtrn oaroesrpntbi ni PTC

submitted by โˆ—agraham416(5)
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I 'odtn ktihn you eenv dha to nwko ahtw sasedie sith aw,s aeuescb I'd I idencto tath eth kid swa nlsogi a tol fo tihgsn ni eht uiren, so ese'trh obpalybr gtmsohien ongwr wthi the nyik.ed eOn of the naim ninstcufo of teh dnkyei si ot eithre obrarseb bcaibr nad sinec seh ahs a rmbeplo ebirranbsgo a tlo of treho fs,tuf I sjtu iferdug aklc of ircbba rtisaeoponrb adem het mots n.sees

submitted by โˆ—titanesxvi(106)
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hwy nto rseceeda CA icavttiy in teh xalimpor uleutb? hsti olsa oudlc edal ot aolictbem ids.iasco

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. +1

submitted by โˆ—charcot_bouchard(572)
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A aecs of cinnaFo dyeos.rmn If ti wsa oladesti pTye 2 TAR otpnio B udwlo eb het enswar.

submitted by โˆ—yb_26(314)
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slonWi easdesi &;t=g nFcoina dyonrmes => aibtlomce sscodaii t(pye II pxlaoirm() )TRA

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