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NBME 21 Answers

nbme21/Block 4/Question#2 (39.6 difficulty score)
A 23-year-old woman comes to the student ...
Obliterative endarteritis with lymphocytes and plasma cells🔍

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iSlspyih tspaoigeesnh is the mfinoanmital nda brinloiatteo of eth saav uvmsaro lm(lsa boold slevse)s ttha fdees erggbi lodbo evsslse kile atroa, irt,resea later.ories It oesd not tetamr twah hte gseta s,i T. limpluad etficns hte aasv uosrmav a,nd ni the ss,crpeo slioaretbet teh resnev dna oobld .vsleses sTih iksll dlobo ulpysp to oeths seara = maseichi ubt on pani pelniass( .cceahnr) eroM ocadelzil in rerliea a,gtess nad ni taler tag,es het shoeicstper tdeeian,miss so uoy haev teh artao nad ainpls orcd vnlvnimotee btu sema hgeostnpeai.s t(d:iE naljGo pdlenexai sith ms.ehowe)er

privatejoker  So is the heavily implied step-wise formation of Syphilis symptoms as presented in FA complete BS then? Why break it down into stages and have us learn it as such if this is not the case in real practice? +4  
lilmonkey  Exactly, Goljan mentioned this in one of his audio lectures. All kinds of lesions in syphilis caused by vasculitis. +3  

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submitted by liltr(22),
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tI is sihli.spy iphSsily is an deti!aserirnt ):

eTh“ tpohialogc gcanesh dteciaaoss hwti iihsypls rae zccraeradhtei yb vittlrbaeoie nsiriattdere atth si ufnod ni lla sstgae fo het .edesasi”

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submitted by oznefu(16),
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uodlC yaenon gvei na laemxep of atwh sedsseai dowul tsbe macth eth retoh eswanr ?oiccesh

vonhippelindau  Leprosy is a noncaseating granuloma fyi. I found that granuloma with suppuration can be caused by blastomycosis according to Robbins (pg 710): “In the normal host, the lung lesions of blastomycosis are suppurative granulomas. Macrophages have a limited ability to ingest and kill B. dermatitidis, and the persistence of the yeast cells leads to continued recruitment of neutrophils. In tissue, B. dermatitidis is a round, 5- to 15-μm yeast cell that divides by broad-based budding. It has a thick, double-contoured cell wall, and visible nuclei (Fig. 15-38). Involvement of the skin and larynx is associated with marked epithelial hyperplasia, which may be mistaken for squamous cell carcinoma.” +1  
usmleuser007  Pyogranulomatous Inflammation An inflammatory process in which there is infiltration of polymorphonuclear cells into a more chronic area of inflammation characterized by mononuclear cells, macrophages, lymphocytes and possibly plasma cells. Actinomyces sp. is gram-positive, acid-fast–negative filamentous bacteria that cause pyogranulomatous infections in dogs, cats, cattle, goats, swine, horses, foxes and human beings. +