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NBME 18 Answers

nbme18/Block 2/Question#27 (27.0 difficulty score)
58 yo man, 4 years of recurrent cough and sputum
Pseudostratified columnar epithelial cellsπŸ”
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 +4 
submitted by lae(19),
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ochricn rsinbcioth aecssu suausmqo lisatampea fo het eitdpduafsetosir oulnamcr ipieuhmtle ni teh rinbcoh dna sloioherncb

---- thees nlaoucrm uhiptemile lrmaynol tintceboru ot the iimryocuacl rneaaelcc dan gmsniko sloa gmasdea tish reecancl,a so nac get eht ulec fmro ahtt oot

donttrustmyanswers  Pseudostratified columnar epithelium is only present in the bronchi. The bronchioles have simple ciliated columnar epithelium. +4  
flapjacks  ^you CAN trust this answer. Confirmed in FA +1  
abcdefbhiximab  Chronic bronchitis is due to hypertrophy and hyperplasia of mucus-secreting glands in BRONCHI where there is pseudostratified columnar epithelium. All of the other answers point to the alveolar sacs. And centriacinar emphysema only affects the respiratory bronchioles anyway while sparing distal alveoli. pg 674 FA 2020 +4  
step7777  It also has to do with the Reid index, which is increased due to mucus gland tissue undergoing hyperplasia and hypertrophy in the Bronchi that is producing excess mucus. Columnar epithelium is usually glandular. pg. 660 FA 2019 +  



 +3 
submitted by lowyield(22),

I was stuck on this one for a long time but maybe my super round about way will help someone?

you know this person has chronic bronchitis (especially cause they have cyanosis which is blue bloater vs pink puffer of emphysema). The distinguishment of pink vs blue is b/c in emphysema you have destruction of both the alveoli with the associated vasculature. Therefore there is no V/Q mismatch (pink). But in chronic bronchitis the damage is further up from the alveoli. All the other answers were in the alveoli so that's how I chose pseudostratified columnar epithelial cells.

Or maybe i'm just dum as hell and this level of overthinking is why i'm losing points on other questions

cbreland  I think this is high yield +