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NBME 20 Answers

nbme20/Block 4/Question#3 (41.3 difficulty score)
A 23-year-old woman comes to the physician ...
Collagen synthesisπŸ”
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 +6 
submitted by champagnesupernova3(72),
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sThi si a ik.delo nI amlorn dwuno nhlaieg yept 3 laeclong is tfsir tezdyeshisn nda neth degeadrd yb iMrtax mtotnpoaliersalee (a asegaencoll iwhch sues iZcn as a oo)rftcca nda rcealped yb yepT 1. In a Kldeio na eicvessex tuoamn of zsodaiirendg eyTp 3 acglnoel p.ssserti ereefroTh het etcedf si ni Calognel ehntisyss (pTey 1 sht)iyssne

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 +  



 +6 
submitted by dbg(149),
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,mIo isht rwsnae iochec si ,grwno heert si on perlobm ni the cssoerp of eoalclng stsehy""sin rep s.e heT uisse si itwh sevcesiex sthssieyn dna rnadeizsodgi odtneopis.i Not na mbraol'na tyntesihc osscrpe' - as duwlo be in DS,E F,M nMekse, ect.

whoissaad  Exactly my reasoning for not choosing collagen "synthesis" +2  
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 +1  



 -3 
submitted by celeste(82),
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oSdsun lkie a ytcprorheiph as.rc rrcH"ophpteiy acsrs aincont lamirrpiy pety III ollanceg dieertno plaralle ot the drpeialme frscaue whti aatdbnnu dsonlue itaogncnni ysofrialosmbbt, ealgr clltxrlaeruae colnglea nsealtifm dan pilutfnle icacid ascamyhpidursecoo."lc pcPl9a//g.v8ipmbMnmt0ws/il73nwCshnc/eh2ct2.r/w/:oi..t

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 +