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Retired NBME 24 Answers

nbme24/Block 1/Question#25 (reveal difficulty score)
A 7-year-old boy has metabolic acidosis and ...
Area labeled โ€˜Bโ€™ (Proximal convoluted tubule) ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—osgoodschlatter10(41)
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Increased Phosphate loss --> Fanconi syndrome --> affects the PCT

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jurrutia  Don't even have to go to Fanconi syndrome. Phosphate is reabsorbed in the PCT and nowhere else. Increased phosphate loss --> PCT +4



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submitted by โˆ—seagull(1933)
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I thought this was a type 1 RTA but I was wrong. Any suggestions?

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seagull  It looks like it was a type II RTA. The difference is incredibly subtle from the info given in this question. +14
gonyyong  He has Fanconi syndrome which is generalized reabsorption defect in PCT which leads to metabolic acidosis and hypophosphatemia โ†’ can lead to rickets Also, does lead to type II RTA +17
duat98  Also the proximal tubule is the place with the highest phosphate absorption rate. That's why PTH works here mostly and a little bit in the distal tubule. +6
boostcap23  Another easy way to go about this one is the question tells you he has metabolic acidosis, the only that can happen with is Fanconi/Type2 RTA. The rest will cause hypokalemia and metabolic ALKALOSIS. (pg 586 FA) Personally thought if they were going for Fanconi syndrome they would describe a lot more symptoms for the kid like growth failure or hypophosphatemic rickets but its NBME so. +2



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