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NBME 20 Answers

nbme20/Block 4/Question#3 (42.0 difficulty score)
A 23-year-old woman comes to the physician ...
Collagen synthesisπŸ”,πŸ“Ί
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 +7 
submitted by champagnesupernova3(75),
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hTis is a dk.leio In oamlnr nowdu elaihng peyt 3 oacglnle is ftirs eidshtzsney nda enth edaergdd by txMria oaletasntepoeirml a( aolagcsnele whchi usse ncZi as a oroa)ctcf nda plercdae yb ypTe 1. In a loideK na ciessexev oamntu fo igdieaodrsnz eyTp 3 nolgclae ts.repssi erreeoThf the tecefd is ni agllCnoe sitssnhye y(Tep 1 eynhsss)it

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 +  



 +7 
submitted by dbg(152),
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o,Im this awrsen cehcoi si rog,nw etreh si on mprebol ni teh srecops fo glloeacn "iynsessh"t pre s.e heT isues si ihwt svexicsee ethsssyin nda rdgnezdiiaso piteodio.ns toN na lmobra'na einthcyst co'rspes - as uwldo be in DE,S M,F e,nMkse c.et

whoissaad  Exactly my reasoning for not choosing collagen "synthesis" +3  
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 +2  



 -4 
submitted by celeste(83),
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osSdnu lkie a rpychihpeotr sa.rc "ptrHyechpior srasc ictnaon limprayri yetp III ecanollg tidonree alaepllr to teh ldmapeier cesurfa wthi ntaubdna nsdoleu nicinnogta ytsmbb,aofilors eralg exlleutaalrcr llgenoac lefismatn nad pfltnleui acidic ohrcca.msiplyde"uocsa Pg.mh/32c0nwisl.o/at/7tw9v/.hbCnni.t8lpMepc/wsi2c/rm:

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 +4  
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 +