NBME 20 Answers : Block 2 : #21 = A 25-year-old woman comes to the physician 2 days ...

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NBME 20 Answers

nbme20/Block 2/Question#21

A 25-year-old woman comes to the physician 2 days ...

Granulomas containing stellate microabscesses

+6 upvote downvote
submitted by sympathetikey(619),

Choice A. would have been correct if this patient was immunocompromised. Per First Aid, "If CD4 <100, Bartonella...Findings: Neutrophilic Inflammation.

However, as this patient has a competent immune system, buzz words are stellate necrotizing granulomas.

yotsubato Everyones choice A is different. +

sugaplum they mean- Diffuse neutrophil infiltration +1

macrohphage95 what does stellate necrotizng granuloma means ? +

krisgsxr600 always with the details! losing dumb points :( +1

futuredoc12345 @sympathetikey Doesn't the biopsy finding vary with the biopsy location: Lymph nodes have stellate granulomas and Bacillary Angiomatosis (skin lesion) has neutrophilic inflammation. What do you think? +

chextra @sympathetikey Pathoma chapter 2 says cat scratch disease forms non-caseating granulomas +

almondbreeze @ chextra Same with FA 2019 pg. 218 +

almondbreeze Sketchy micro: Immunocompetent: regional LN in axilla in one arm (like our pt here) Immunocompromised: bacillary angiomatsis is transmitted by cat scratches +

+2 upvote downvote
submitted by sugaplum(123),

B Hensele- Cat Scratch in immuno-compotent - http://www.pathologyoutlines.com/topic/lymphnodescatscratch.html Bartonella henselae in Immuno-compromised- Baciliary angiomatotsis Looks like kaposi sarcoma "Diffuse neutrophilic infiltrate" FA 2019 177

almondbreeze FA 177 says Kaposi has lymphocytic inflammation whereas Bartonella spp has neutrophilic inflammation. I guess this does not apply when immunocompromised? But doesn't Bartonella usually affect the immunocompromised ppl? +

almondbreeze Got it after seeing that she's immunocompetent +

+1 upvote downvote
submitted by neonem(372),

Cat scratch disease (Bartonella infection in immunocompetent hosts) causes lymphadenitis (especially in the axillary region) characterized by sarcoid-like non-caseating granulomas filled with neutrophils.