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NBME 24 Answers

nbme24/Block 3/Question#35

A 4-year-old girl has a history of multiple bone ...

Scar formation

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

sympathetikey  Feels bad man. +2  
zoggybiscuits  Those Sclera sure look blue. wow. +3  
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. +4  
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" . +1  

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.

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).

wowo  FA 2019 p51 +  

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

 +0  upvote downvote
submitted by sweetmed(83),

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