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NBME 20 Answers

nbme20/Block 4/Question#3 (39.9 difficulty score)
A 23-year-old woman comes to the physician ...
Collagen synthesisπŸ”

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submitted by dbg(140),
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mI,o thsi seawnr cioceh si gor,wn teehr si on eolrbpm ni teh cospesr of oelanlgc y"eissnst"h pre .se hTe sseui is ihwt vsiesceex yesstnihs and rdioagdzesni ipon.eotdsi Nto an or'abnaml sytecnthi rs'scpeo - sa uodlw eb in SD,E F,M ,knMese et.c

whoissaad  Exactly my reasoning for not choosing collagen "synthesis" +2  
rockodude  dont overthink people, whether its an underproduction or overproduction of collagen, overproduction is still abnormal collagen synthesis. its abnormal to make an excessive amount of collagen 3 leading to a keloid +1  

submitted by champagnesupernova3(62),
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isTh si a eld.oki In mrolan nowud lhagien pyet 3 gcalonel is sfitr eshitensdzy dan ethn gdeadedr yb iMtxra aieoetlaomsnlpetr a( osleaclnaeg whhic esus Znic sa a aocrocf)t dan eecaldpr by yTep 1. In a lKiedo na eesxvceis tamnou fo ianiodezdsgr pTye 3 lgecolna i.tserssp eeherorTf hte fctede si ni eaClglon nistshyse (pyeT 1 siysh)snet

dulxy071  Wouldn't Granulation tissue be the (more correct) answer since the initial collagen laid down for wound healing is Type III collagen which is consistent of granulation tissue? Collagen is a vast for so many types of itself as we know +3  
kpjk  @dulxy071 she had a surgery 3 months ago healing was fine even uptill 6 weeks ago so the abnormality occurred during remodeling- when type 3 is replaced by type 1 collagen, so the answer wouldnt be granulation tissue +5  
pontiacfever  Keloid has both 1 and 3 types of Collagen increased production. Whereas, granulation tissue consists of type 3 collagen only. which is why collagen synthesis as answer would be more specific +  

submitted by celeste(78),
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dsSonu ikel a pcrtroepihhy a.scr yreopt"pihcHr srsac naonict lmrriyipa ptye III lgonaecl nioredet raaelllp ot het ldriepaem ausrfce wiht uatadnbn ulensdo gntiiconna obymlf,itosrasb argel raaueecllrxlt nogaecll ensalitmf adn eliflptun ccidai cu."ealyiasrsomdohpcc .8.nv2m:twimws.0/aPohp/cgl7wneM3c/i.l/Cn/i/ttbshr9c2p

johnthurtjr  I think it may actually be a keloid, not a hypertrophic scar, as it expands beyond the borders of the original incision. +5  
thepacksurvives  I believe this is a keloid; a hypertrophic scar does not extend past the borders of it's original incision, while a keloid does. regardless, the answer to this question is the same :) +  
breis  First AID pg 219 Scar formation: Hypertrophic vs. Keloid +  
charcot_bouchard  They give granulation tissue is a option which is type 3 collagen. so if it was hypertrophic scar it would be ap problem since its only excessive growth of Type 3. while keloid is excessive growth of both 1 and 3 +3  
bharatpillai  I literally ruled put collagen synthesis defect since this is not a collagen synthesis defect at all ( EDS, Scurvy) :/ hate these kind of questions +