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jointaccount  Left breast & L UE drained by axillary. With the remaining choices, R kidney is the only choice outside the territory of the right lymphatic duct

 -1  (nbme20#35)

Looked like hepatosplenomegaly, but I went with liver b/c the edema could be due to liver dysfunction.

 +0  (nbme20#25)

It's a mitochondrial disease. - present in successive generations, always with maternal transmission - damage to high-energy tissues - CSF lactic acidosis (due to increased anaerobic metabolism due to impaired oxidative phosphorylation)

 +5  (nbme20#36)

Lipomas/Liposarcomas are the commonest soft-tissue tumors in adults. The high mitotic index & infiltrative nature indicate that the mass is malignant.

 +1  (nbme20#32)

They tell you that the kid has no clavicle. This means the defect is in membranous ossification, NOT endochondral, so the pathology is NOT going to involve the chondro-whatever cells. decreased ALK is consistent with osteoblast defect.

pakimd  isnt increased alk phos consistent with increased osteoblastic activity?
eacv  @pakimd Yes ! ALK phos is a measure of osteoblast work, if the are not working is LOW as in thix px.

 +5  (nbme20#34)

The first sentence acknowledges the patient's emotions, which is always good. The second sentence is good because it begins the interview with an open-ended question.

 -10  (nbme20#42)

Answer is Astrocyte. Patient has glioblastoma multiforme. Although meningiomas may occur at convexities, meningiomas are benign and often asymptomatic. They may cause h/a seizures, but would be unlikely to cause death w/in 6m of onset of h/a. The size of tumor and course of illness is consistent with the course of GBM

masonkingcobra  Above is obviously incorrect because the answer is Meningeal lol. Here is a link to a good picture: http://neuropathology-web.org/chapter7/chapter7fMiscellaneous.html
kernicterusthefrog  Obviously thomas is disagreeing with the presentation of the question, and I agreed with him! This absolutely sounds like GBM, with rapid onset leading to death, and the symptoms. The question stem leads you to GBM, and the gross image to meningioma (I guess).
kernicterusthefrog  Furthermore, where are the meninges on the gross image form which this (meningioma) grew?! It should at least show the tissue from whence it came!
nala_ula  Had the same problem, got confused since it appeared that the growth was malignant :(
sugaplum  FA 2019 pg 514, also agree with everyone. weird presentation. Glios are malignant death within 1 year, meningioma are often asymptomatic or have focal signs. just a gross pathology question at this point
garima  ı think she died bc of pressure or something guys, its obviously round shaped benign lesion, its also extra axial not like GBM. she had this maybe years before death

 +0  (nbme20#47)

Not sure about this, but it seems to me that this is referring to "pseudocholinesterase inhibitor deficiency. It's an enzyme defect that is triggered by NMJ blockers - succinylcholine or curare's.


usmleuser007  I believe this question was stating that AchE activity was abnormal = it was not lowering the Ach activity. Which suggests that another ligand like Ach was being used.

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