I don't like how they are asking this, but I think what they are getting at is that after the stent placement ("subsequent to the stent placement") there will be reperfusion injury to the myocardial tissue which occurs through free radical injury and therefore membrane lipid peroxidation is the best answer (FA2020 p210 mentions membrane lipid peroxidation as a mechansism of free radical damage and lists reperfusion injury after thrombolytic therapy as a type). Elevations in the cardiac enzymes I assume are because of the injury to the cells.

The question stem is referring to a conjugate vaccine. This is because conjugate vaccines convert T-independent antigens (polysaccharides) into T-dependent antigens by conjugating them with a protein. [FA2020 p127]

Remember that in order for a T-cell to be able to respond to an antigen via MHC, it MUST be a protein. Thus, T-dependent (dependent on T-cells) responses are to proteins. T-dependent responses are overall better because then B-cells can then undergo affinity maturation and class switching through interaction with T-cells. So, by conjugating bacterial polysaccharides to proteins, the immune response will be a more robust T-dependent reaction and will yield better protection. [FA2020 p103]

Conjugate vaccines exist for encapsulated bacteria (as the capsules are polysaccharide and would need to be conjugated to protein to improve response). These are Neisseria meningitidis, Haemophilus influenzae, and Streptococcus pneumoniae

You can remember these encapsulated organisms and their conjugate vaccine because they are THE SAME organisms that you become susceptible to when you have a splenectomy and which necessitate vaccination.

Pelvic splanchnic nerves carry the parasympathetic fibers that are responsible for hindgut intestinal motility including voiding (image). [FA2020 p364].

Diabetes mellitus can cause nerve damage and gastroparesis, treated with metoclopromide (FA2020 p400).

Just to add to the explanation here is what you would see in the others (most on FA2020 p484)

• Basal cell carcinoma:
• "Palisading" nuclei as well as nests of neoplastic basal cells.
• Typically presents as a pearly, indurated nodule but can be a scaling plaque


• Keratoacanthoma:
• Resembles squamous cell carcinoma in that it is a rapidly growing dome shaped nodule with a keratin filled center
• On histology it basically presents as a crater filled with keratin


• Malignant melanoma:
• Bad boi, look for the ABCDEs (asymmetry, border irregularity, color variation, diameter >6mm, and evolution)
• On histology you see melanocyte proliferation below the basement membrane and it just looks uglier


• Merkel cell carcinoma:
• Rare and typically appears as flesh colored or bluish nodule