NBME Free 120 Basal Ganglia (NBME Answers)

NBME Free 120 Answers

free120/Block 3/Question#39 (reveal difficulty score)
A 32-year-old with 2 years of abnormal hand ...
Basal Ganglia 🔍 / 📺 / 🌳 / 📖
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submitted by ∗lpp06(41)

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I have no idea what the diagnosis is (HD is tough to rule in since they're indicating a disease with maternal anticipation, which I think is rare for HD?)

However - he has extrapyramidal movement disorders with no signs of damage to sensory columns (intact sensation), cerebellar (no intention tremor/dysmetria), and frontal lobe (normal mental status exam). I can't explain why the increase in DTR, but EPS + nothing else that can definitively rule in another area means this is most likely basal ganglia

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ootscoot I agree with you - I was thinking HD when they alluded to anticipation, but was thrown off by the maternal part. Does anyone know what they're alluding to when they said "unable to fix his gaze on one point or protrude his tongue for more than 30 seconds?" Is that describing EPS? Oculogyric crisis is involuntary prolonged upward gazing (not an inability to fix his gaze) & orofacial chorea is involuntary repetitive movements (not inability to protrude the tongue). Am I missing something? It's entirely possible at this point of dedicated. My brain is gobblygook +5

koko Isn’t it all part of the choreiform movements the eyes and tounge.... +

doublethinker Trick is, I think, that HD is Autosomal Dominant. Though it may be rare to get anticipation through the mom (I forget the exact reason why but it's something with genetics) I think they just wanted to emphasize it is possible. +

jbrito718 Definitely HD- depression/anger, fam hit., choreiform movements--> unable to focus on one point or keep tongue from moving! HUNT-4-Caudate is how I like to remember this +

handsome guys do you have link to free 120 couldn't find it.. -___-. . . +

an1 for real? just google nbme or usmle free 120 you'll see it @handsome +

drdoom @handsome here you go: https://orientation.nbme.org/Launch/USMLE/ +

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submitted by tl285(1)

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i was definitely thinking essential tremor as soon as I read "gets worse when he feels angry or depressed." makes sense that his mom and grandma has it since it's commonly familial. it can either be intention (which they said it's not in the question stem) or also postural. also makes sense that he can't fix his gaze (since it can affect the head) or keep his tongue stuck out. all of this would point to cerebellum and agree with previous comments it didn't seem like the classic HD presentation which led me to getting the q wrong so idk guess i have more to learn...

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zolotar4 I struggle with Essential Tremor(ET) too. So essential tremor is intentional or postural - meaning tremor with action or a sustained position even against gravity. So , for example, our patient would've either had difficulty writing or tremor with their arms outstretched. Also ET usually presents over 40, w/o anticipation. +

zolotar4 here's a visual for postural tremor -http://hkuelcn.med.hku.hk/postural-tremor/ +

an1 Lack of intention tremor or dysmetria rules out cerebellar disease. Tremor can be from a lot of areas in the brain +

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