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Retired NBME 13 Answers

nbme13/Block 4/Question#42 (reveal difficulty score)
A 64-year-old woman comes to the physician ...
Esophageal peristalsis: decreased; Lower esophageal sphincter tone: decreased ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—scoresloth(3)
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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5825946/

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submitted by cv020496(1)
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Scleroderma (systemic sclerosis) - Triad of autoimmunity, noninflammatory vasculopathy, and collagen deposition with fibrosis. Commonly sclerosis of skin, manifesting as puffy, taut skin A without wrinkles, fingertip pitting B . Also sclerosis of renal, pulmonary (most common cause of death), cardiovascular, GI systems. 75% female. 2 major types:

Diffuse sclerodermaโ€”widespread skin involvement, rapid progression, early visceral involvement. Associated with anti-Scl-70 antibody (anti-DNA topoisomerase I antibody).

Limited sclerodermaโ€”limited skin involvement confined to fingers and face. Also with CREST syndrome: Calcinosis C , anti-Centromere antibody, Raynaud phenomenon, Esophageal dysmotility, Sclerodactyly, and Telangiectasia. More benign clinical course

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