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Retired NBME 16 Answers

nbme16/Block 1/Question#48 (reveal difficulty score)
A 12-year-old boy is brought to the physician ...
Abnormal myelin sheaths ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +7  upvote downvote
submitted by daddyyikes(2)
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it is charcot marie tooth disease as it is inherited and with abnormal myelin sheath, foot drop, hammer toe etc.

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cheesetouch  fa18 p 508 +2
giantotter  FA 2020 524 +
lovebug  FA2019 p512 +



 +1  upvote downvote
submitted by โˆ—aoa05(34)
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A high stepping gate implies distal more than proximal weakness. Hammer toes are a finding in Charcot-Marie-Tooth (hereditary motor and sensory) neuropathies, most of which also feature demyelination of peripheral myelin sheaths. Slowing of nerve conduction velocities could have demonstrated the same thing less invasively.?

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notyasupreme  Ask me why I thought this was Friedreich Ataxia and not CMT fml lol +
shakakaka  Why did you think that it's FA? +1
fatboyslim  @notyasupreme because Friedreich's has hammer toes? +



 +1  upvote downvote
submitted by โˆ—topgunber(68)
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hardest part for me was differentiating absence of schwann cells vs abnormal myeling sheaths. Schwann cells come from neural crest cells so we would expect to see other neural crest migration issues in my opinion. CMT disease has motor and sensory issues because PMP-22 peripheral myelinating protein is mutated. leads to abnormal myelination of the peripheral nerves. foot drop from sensory degradation, muscle atrophy from motoneuron involvement (also peripherally myelinated)

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topgunber  foot drop from motor degradation , high stepping gait from sensory degradation. also associated with hearing issues. +
proteinbound123  I think it should be: high stepping gait from foot drop from motor degradation from CMT neuropathy that can cause motor (like this) or sensory abnormalities. +



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