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NBME 18 Answers

nbme18/Block 1/Question#11 (reveal difficulty score)
67 yo man, fine resting tremor in both hands
Alpha-synuclein ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: neuro repeat

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submitted by โˆ—wishmewell(59)
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I was confused between Alpha- Synuclein and Tau. This patient has parkinsons diseases and thus we would see Alpha synuclein.

Tau is seen in patients with Picks disease, aka Frontotemporla dementia AND alzheimers disease. page 504. FA 2018

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baja_blast  FA 2019 p. 508 +
jbrito718  The gross image also shows the medulla, where you can see some darkness around the edges, reprentative of the substantia nigra which is affected in Parkinsons. Another hint +1
epiglotitties  *The gross image shown is of the midbrain, the image on the left was from a normal px and on the right our px with Parkinson's. Comparing his gross specimen to the control we can see depigmentation (represents the loss of dopaminergic neurons) of the substantia nigra. +
namesthegame22  Amyloid plaques and abnormal tau accumulation are pathologic markers of dementia, Alzheimer type. Amyloid plaques are extracellular protein accumulations, while tau forms intracytoplasmic and extracellular protein tangles. +

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submitted by โˆ—andro(269)
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Intracellular aggregates in neurodegenerative conditions :

Alpha synuclein- a protein mainly found in terminal axons which can aggregate and deposit intracellularly to form Lewy Bodies . These are associated with the neurodegenerative conditions 1. Parkinsons Disease 2. Lewy Body Dementia

Neurofibrillary tangles - hyperphosphorylated tau protein , number of tangles correlates with degree of dementia

Pick bodies - hyperphosphorylated tau . these are round aggregates though in contrast to neurofibrillary tangles. Seen in Frontotemporal dementia and other neurodegenerative conditions

Hirano bodies - intracellular aggregates of damaged actin filaments seen in various neurodegenerative conditions e.g AZ , ALS , Creutzfeldt-jakob Disease ( These are not really tested on )

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