NBME Answers : samadmom's page

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submitted by aesalmon(95), visit this page

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Leydig cell hyperplasia, should also see fibrosis and hylinazation of the tubules but i'm not seeing it... ¯_(ツ)_/¯

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meningitis I think its there.. I thought it was the lighter red/pink material (hyaline material) And I thought the white streaks were the fibrosis like "streaked ovaries"in Turners. +

samadmom Apparently the histology looks like leydig cell hyperplasia but is actually called "pseudoademonatous clusters" and are reduced in number due to increased FSH and LH. +

submitted by taediggity(44), visit this page

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2/6 systolic murmur over the left sternal border,an S3 (increased LV filling), low 02 sat, figured this patient had hypertrophic cardiomyopathy and early signs of CHF, so the answer was crackles from the pulmonary edema from fluid back up from the HF as brise pointed out below the 1st comment.

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samadmom I believe this patient actually has dilated cardiomyopathy (as opposed to hypertrophic) due to his age, HTN, presence of S3 (hypertrophic usually has S4), and also his murmur. The murmur indicates mitral regurg, the tip-off was "radiating to the axilla". Because the stem states that the PMI is diffuse this can lead us to think that his heart has enlarged in an unpredictable way (ie. making it acceptable that the placement of the murmur is different from where we expect). Lastly, secondary mitral regurg is an indicator of poor prognosis for HF. Once the ventricle has dilated to such a point, the mitral leaflets are unable to properly close and perpetuate the backward flow of blood. Hope this helps! +2