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Retired NBME 19 Answers

nbme19/Block 2/Question#34 (reveal difficulty score)
A 69-Year-old woman comes to the physician ...
Area marked "D" ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—surgerydoctorca_sgu(6)
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(FA 2021, Pg. 538)

This patient has Parkinson disease. This question is asking you to identify where the problem in the brain occurs which is in the basal ganglia. Within the basal ganglia is the dopaminergic neurons of the substantia nigra. It is these neurons the become lost slowly over time and grossly (depigmentation)occurs at the substantia nigra pars compacta specifically.

Also, make note that histologically you will see Lewy bodies. These are composed of alpha-synuclein (intracellular eosinophilic inclusions).

A good memory anchor for this one is to know that this is what Robin Williams is said to have died from.

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