NBME 21 Mammillary bodies (NBME Answers)

NBME 21 Answers

nbme21/Block 3/Question#8 (reveal difficulty score)
A 55-year-old woman is brought to the ...
Mammillary bodies 🔍 / 📺 / 🌳 / 📖
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+12 upvote downvote
submitted by ∗hungrybox(1277)

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Wernicke-Korsakoff syndrome due to thiamine (B1) deficiency. Common in alcoholics.

The reason why they said "results of alcohol and drug screen are negative" is that the differential includes acute alcohol intoxication.

Wernicke's triad:

confusion
paralysis of eye muscles (ophthalmoplegia)*
ataxia

*presents here as nystagmus

Korsakoff's psychosis:

memory loss (anterograde and retrograde)
making shit up (confabulation)
personality change

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teepot123 fa 19 pg 559 +1

+3 upvote downvote
submitted by ∗hayayah(1212)

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Wernicke-Korsakoff syndrome. Don't have to be an alcoholic to get this, just usually is related to alcoholism / thiamine deficiency.

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d_holles Yeah the negative EtOH screen threw me off +5

dr_jan_itor Why cant it be early alzheimers and hippocampus? She could easily have been a former prominent physician and member of city council. Am i supposed to assume that simply because shes disheveled and poor hygeine that she must be an alcoholic homeless person? It also mentions no symptoms of nystagmus, ataxia, etc. +4

kimcharito it said broad based gait and nystagmus +12

lilmonkey She is/was an alcoholic and appears pretty much homeless, just not drunk at this moment. +2

fatboyslim @ dr janitor. The question says "physical exam shows a broad-based gait and nystagmus." +

suckitnbme NBME questions also stereotype the shit out of their patients +6

+2 upvote downvote
submitted by ∗mrglass(47)

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Despite the patient not being intoxicated, this patient is presenting with classic findings of Wernicke-Korsakoff syndrome. Even if you figured that Thiamine deficiency wasn't likely given the history, if you know that WKS causes mammilary body atrophy, and this "mystery disease" is causing similar symptoms to WKS, you can guess that this "mystery disease" is causing mammilary body atrophy

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+1 upvote downvote
submitted by ∗ibestalkinyo(60)

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Anyone find it strange that the NBME loves to write questions where physicians are alcoholics?

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athenathefirst Their job is to find our flaws haha +

tadki38097 this patient isn't actually a physician, they are trying to show that the patient has confabulation (making up stuff but truly believing it) +

sarahs good point...negative alcohol screening threw me off +

sunnyside holy shit... i didn't even stop to think that she wasn't actually a physician. smh i guess i just trust my patients too much s/o nbme for setting me straight +

+0 upvote downvote
submitted by swagcabana(8)

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Ppl remember that if you get shit face drunk, wait a day and then take a ETOH screen, its not going to be positive. Don't necessarily rule out alcoholism if an ETOH screen is negative

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+0 upvote downvote
submitted by ∗umpalumpa(6)

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Alzheimer can be ruled out because pt is "pleasant and cooperative", whereas non-cognitive symptoms of Alzheimer include "aggression, irritability, agitation".

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