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NBME 20 Answers

nbme20/Block 1/Question#21 (34.5 difficulty score)
A 75-year-old woman comes to the physician ...
Multinucleated giant cells and neutrophil infiltratesπŸ”
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 +7 
submitted by hayayah(1057),
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Tshi is an exemapl fo e.shliSgn Hepesr smlpixe nda epsrhe zsotre sevrius acues aalnorbm ecll nidvoisi in melaerpid l,secl dan tish reetacs atteiuduelmlnc ignta cle.sl

A zankT samre owshign timaeenuuldltc niatg lsecl si caiacshtrierct fo alarcVeil Zrseto urVsi ntoin.fesic HSV( lilw vaeh rmliisa d)nfgisin.

ergogenic22  other identifying terms for herpes: Single dermatome (does not cross the midline), painful (burning and itching),and lesions in multiple stages. +3  
redvelvet  and why neutrophile infiltration, is it a thing? or just a distracting thing? +1  
charcot_bouchard  Neutrophil comes into party always first. but it was distracting for me too. +6  
dulxy071  Regardless if it can help resolve the issue, neutrophil will always be the first responder +2  



 +0 
submitted by victor_abdullatif(0),

Branching fungal hyphae without yeast forms = probably Sporotrichosis / Sporothrix schenckii

Diffuse separation of dermis and epidermis = Stevens-johnson / TEN

Granular depositis of IgA at the tips of dermal papillae = dermatitis herpetiformis

Immunofluorescent staining for C3 along the epidermal basement membrane = bullous pemphigoid

Nonbranching fungal hyphae with abundant yeast forms = ? (maybe tinea?)




 +0 
submitted by andremosq(2),

HSV identification FA20. 166 Tzanck smear - Multinucleated giant cel, but PCR is the test of choice. Picture here https://healthjade.net/tzanck-test/