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NBME 21 Answers

nbme21/Block 3/Question#8

A 55-year-old woman is brought to the emergency ...

Mammillary bodies

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 +8  upvote downvote
submitted by hungrybox(433),

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

 +3  upvote downvote
submitted by hayayah(603),

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

d_holles  Yeah the negative EtOH screen threw me off +1  
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. +1  
kimcharito  it said broad based gait and nystagmus +2  
lilmonkey  She is/was an alcoholic and appears pretty much homeless, just not drunk at this moment. +  
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 +2  

 +1  upvote downvote
submitted by mrglass(6),

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

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