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NBME 24 Answers

nbme24/Block 3/Question#35 (reveal difficulty score)
A 4-year-old girl has a history of multiple ...
Scar formation 🔍 / 📺 / 🌳 / 📖

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 +67  upvote downvote
submitted by atstillisafraud(217)

Thank you NBME for the high quality pictures. It makes these exams stress free and enjoyable.

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sympathetikey  Feels bad man. +3
zoggybiscuits  Those Sclera sure look blue. wow. +21
yotsubato  the same girl shows up on so many NBME exams its not even funny. Its just like that poor kidney that's cut in half that shows up in all kidney questions. +15
aneurysmclip  I turned my brightness up and down 2 times to make sure it wasn't my brightness messing with the sclera. I'm declaring it, NBME stands for "Naturally Bad at Making Exams" . +6
peqmd  $60 a pop and no competitors...That's what happen when there's a monopoly. +9
peqmd  Actually they used their best software to generate images. You might have heard it before, it's called MS Paint. Quite legendary. +9
feochromocytoma  It feels like they cranked up the contrast and saturation on a normal eye to make it look "blue"... +6
rockodude  everyone hates on nbme, but they're showing you a picture zoomed in of her eyes and she has a history of multiple fractures/bad wound healing at the age of 4, I feel like OI should at least be a consideration based on the overall clinical picture +1
feochromocytoma  Yeah I got it right, it's just funny that they don't use higher quality pictures for the exam +1
djeffs1  that is clearly a malar rash... oh wait nvm just pixellation +4

 +20  upvote downvote
submitted by itsdrgoodwood(20)

The diagnosis is Osteogenesis Imperfecta. Disease causes a defect in Type 1 Collagen that leads to “brittle bones”, meaning the patients have frequent fractures with little trauma. Type 1 collagen is also a major component of the sclera -> this is what the picture was hinting at (i think?) and it causes “blue sclera”. The sclera are thin/translucent so they look blue due to underlying choroidal veins.

Finally, patients have poor wound healing. Wound repair with granulation tissue involves type 3 collage which is then converted to type 1 collagen during scar formation. Defects in type 1 collagen obviously don’t allow this process to take place.

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 +9  upvote downvote
submitted by misterdoctor69(70)

Damn everyone out here looking at the eyes when my dumbass was thinking the girl was missing a nasal bridge or something lol fml

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peridot  That is straight up what I wrote: "low nasal bridge???" I was like is this part of some congenital defect +
mkayman  lmfao +

 +3  upvote downvote
submitted by adisdiadochokinetic(89)

It really looks to me like her sclera have been photoshopped, anyone else notice that? xD

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 +2  upvote downvote
submitted by gainsgutsglory(38)

She has Osteogenesis Imperfecta. Aka “Brittle Bone Dz” aka Collagen Type I deficiency. U need collagen type I to make scars (granulation tissue is type III and then metalloproteases and zinc cofactors help digest into the firm type I collagen).

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wowo  FA 2019 p51 +

 +2  upvote downvote
submitted by syoung07(58)

fam I had almost convinced myself I was looking at some epicanthal folds

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 +1  upvote downvote
submitted by sweetmed(157)

I legit thought her oversized pupils were the problem. What genius decided to use this photo.

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 -1  upvote downvote
submitted by j44n(141)

Just another piss poor government institution cutting corners. If you've done NBME 18 and seen the cell diagram figure it is the literal pinnacle

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drdoom  the NBME is a private, for-profit corporation. individual U.S. states use its products (i.e., the certification it gives you when you pass their exams) to determine your eligibility to practice in their state. but they are not a government entity. +1

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