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Retired NBME 16 Answers

nbme16/Block 3/Question#25 (reveal difficulty score)
A 46-year-old man comes to the physician ...
Neuronal degeneration ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—cassdawg(1781)
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This man presents with classic features of Parkinson Disease which is caused by degeneration of dopamine producing neurons in the substantia nigra (FA2020 p520)

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ibpstepprep  most likely Chronic traumatic encephalopathy (CTE), Parkinson like symptoms and history of boxing/ traumatic sport. Repetitive trauma results in neuronal degeneration and Tau deposition. +11
shieldmaiden  The problem with a diagnosis of CTE here is that it shares more sxs and etiological features with Alzheimer's, making it a cognitive-heavy disease rather than movement, like what is seen in this patient. The repeated trauma might have played a part but in this case, where a person is having trouble with movements, not memory, behavior, personality, or mood, I think is more accurate to say that it's Parkinson's and thus neuronal degeneration and not a tauopathy. +2
msula  Why is this not a ALS ? +
shieldmaiden  @msula I think ALS is not associated with sleep disturbances, pain, or tremors. Furthermore, the question points you to a defect in the patient's brain, so that also r/o ALS +
fatboyslim  RIP Muhammad Ali +



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