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NBME 20 Answers

nbme20/Block 1/Question#21

A 75-year-old woman comes to the physician because ...

Multinucleated giant cells and neutrophil infiltrates

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submitted by hayayah(447),

This is an example of Shingles. Herpes simplex and herpes zoster viruses cause abnormal cell division in epidermal cells, and this creates multinucleated giant cells.

A Tzank smear showing multinucleated giant cells is characteristic of Varicella Zoster Virus infections. (HSV will have similar findings).

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