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Old 01-07-2013
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I agree NBME 7 Discussion

Block 4:
Q 24:Why can't this be personality disorder schizotypal??
Magical thinking and all..

Q 25:I agree osteoblasts inc after a frac to form new bone..But can there be inc osteoclast act which has weakened bones predisp for frac??

Q 34 :I think huntington's carry complete penetrance so why can't this be 100% risk.How to interpret this graph?

Q 49: Fall->epidural hematoma->transtentorial hern->Uncal herniation..Is uncal hern answer for this?
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Old 01-07-2013
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24) No where in the question stem has there been a mention of magical thinking or any other characteristics of schizotypal like behaviour at all.

In fact some of the key words to get you thinking along bipolar lines would be "recently had a burst of energy", "awake around the clock writing furiously at his desk". The lack of any past drug intake history rules out drug related causes.

Not to mention, in the options provided, bi polar is the most obvious choice :-D

25) A 36 year old normal individual isn't likely to have a cause to predispose him for fractures. Such stress fractures are common in normal individuals, especially in the lower limb, during periods of increased work and stress on the leg.

If it was a post menopausal woman, or the location of the fracture the vertebra or the pelvic girdle, you might have had reason to think about a predisposition for fracture (like osteoporosis), but a 36 year old male who runs regularly, unlikely.

34) The way i see this question is, Huntingtons being AD inheritance, and this particular patient having on allele with 6 CAG repeats and the other allele with 15 CAG repeats, with an AD inheritance pattern, it is the 15 CAG repeats which would manifest as a phenotype in this patient, which on the graph corresponds to near 60%

I know there are other explanations to this online, but this is how i see it.

49) Yes, uncal herniation is right. Signs of EDH (lucid interval), damage to IIIrd nerve, and opposite side hemiparesis all indicate uncal herniation.

Hope this clarifies matters!
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Old 01-07-2013
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Thanks a lot for the explanation..
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