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⚗️ Question 1: Type 2 RTA Pathophysiology A 6-year-old child presents with muscle weakness, polyuria, and failure to thrive. Labs reveal: HCO₃⁻: 16 mEq/L K⁺: 2.9 mEq/L Urine pH: initially greater than 5.5, but later lower than 5.5 Anion gap is normal. Which of the following is the most likely mechanism? A. Inability of α-intercalated cells to secrete hydrogen ions B. Impaired HCO₃⁻ reabsorption in the proximal tubule C. Aldosterone deficiency D. Increased Na⁺/K⁺ exchange in the collecting duct ✅ Answer: B. Impaired HCO₃⁻ reabsorption in the proximal tubule Explanation: In Type 2 RTA, the proximal tubule cannot reabsorb filtered bicarbonate, leading to bicarbonaturia and metabolic acidosis. Urine pH is variable: initially high, but later acidic as HCO₃⁻ is depleted. 🧪 Question 2: Diagnostic Pattern A patient with Fanconi syndrome has polyuria, hypokalemia, glucosuria, and non-anion gap metabolic acidosis. What is the primary cause of the acidosis? A. Aldosterone resistance B. Loss of bicarbonate in urine C. Impaired NH₄⁺ excretion D. Increased ketogenesis ✅ Answer: B. Loss of bicarbonate in urine Explanation: Fanconi syndrome involves generalized PCT dysfunction, leading to HCO₃⁻ wasting (Type 2 RTA), among other solute losses. 💊 Question 3: Treatment Response A child with Type 2 RTA is given oral sodium bicarbonate. Despite therapy, acidosis persists. Why? A. Urine pH remains alkaline due to distal RTA B. Proximal tubules continue to waste bicarbonate C. Aldosterone blocks distal acid excretion D. ADH resistance prevents water reabsorption ✅ Answer: B. Proximal tubules continue to waste bicarbonate Explanation: In Type 2 RTA, the proximal tubule has a limited capacity to reabsorb HCO₃⁻, even with supplementation, making correction difficult. 🧬 Question 4: Associated Syndromes Which of the following inherited disorders is commonly associated with proximal renal tubular acidosis (Type 2 RTA)? A. Alport syndrome B. Bartter syndrome C. Fanconi syndrome D. Liddle syndrome ✅ Answer: C. Fanconi syndrome Explanation: Fanconi syndrome causes generalized dysfunction of the PCT, including loss of glucose, amino acids, phosphate, and bicarbonate. 🧠 Question 5: RTA Type Comparison Which feature differentiates Type 2 RTA from Type 1 RTA? A. Hyperkalemia B. High urine pH persistently C. Low urine pH after bicarbonate is depleted D. Increased anion gap acidosis ✅ Answer: C. Low urine pH after bicarbonate is depleted Explanation: In Type 2 RTA, once plasma HCO₃⁻ is reduced, the distal nephron can acidify urine (pH lower than 5.5), unlike in Type 1 RTA. #USMLE #PRRevalidación #MedicalQuestionBank #ClinicalVignettes #DoctorRamon #DirtyMedicine #NinjaNerdOfficial