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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

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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.