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NBME 22 Answers

nbme22/Block 3/Question#45 (49.8 difficulty score)
A 28-year-old man who is seropositive for HIV ...
Slit-like vascular spaces with plump spindle-shaped stromal cells🔍

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 +20  upvote downvote
submitted by usmleuser007(326),
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ym lsit fo espdinl etyp lescl and icsinonto:d

  • .a F-N1
  • .b -2NF ~ naamohSwcn oitnA(n )A = snueutCao oorebiurafnm ~ ihhg tiyleurclla (w/ pinaigslad nsarettp ihwt stiserneinpgr crre-nauflee nzeso aVcoe;bdsryelnplca& iesdob
  • .c oeoyLmami etruu(s mp&a; upahsoseg)
  • d. Mhooaseetlmi tikatercoyn( io)psveti
  • e. spailnActa rdyoihT crnaec ab(chsiip mp&a; ngola htwi tgnia cells)
  • .f dluerMaly yhdoTri ccenar (nac lsao vaeh ylpnlaogo ell)cs
  • .g aryPimr crciada smoaraingcoa nnmtgi(ala rsuvaacl nlsdpei el)lsc
  • h. seomcoOrsaat onbe( )racnec iope(rmlchop clse)l
  • .i noinMegmia
  • .j psai'soK araomSc V(-)HH8 = lkiietS-l suacvarl asescp ihtw ulmpp eaidps-sdplneh amlsrto cesll
drdoom  @usmleuser007 to make lists display correctly, try using the plus sign (+) for each "bullet point"; that should work +1  
mcl  I love this and I love you +2  
usmleuser007  LOL thanks, had to ddo a lot of digging since "spindle cells" are commonly tested +2  
leaf_house  @uslmeuser007 "MAMML PONNK" is the best I can do with that +  

 +11  upvote downvote
submitted by drzed(177),

(A) aggregates of large atypical lymphocytes = infectious mononucleosis (CD8+ T cells responding to EBV infection in CD21+ B cells)

(B) Granulation tissue containing pseudohyphae and budding yeasts = candidiasis

(C) Intracellular yeasts in macrophages = histoplasmosis

(D) Macrophages containing acid-fast bacilli = mycobacterium

(E) Multinuclear cells containing intranuclear inclusions = cytomegalovirus (or most members of the herpesvirus family)

 +2  upvote downvote
submitted by mcl(517),
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To dpaxen on h,sti auootspgoylltnhei sicdesbre eth shoioygtl fo wsopiak aramocs sa lpni"esd lslec nfgomir itssl tiwh tatrxaaedsev dre olodb slec"l

mcl  lul i don't know why i spell kaposi like that, my b +8  
bubbles  This site is super helpful. Thanks for sharing :) +  
mcl  yesssssss ofc <3 I love path outlines +  
usmleuser007  Just realize that spindle cells are similar to the endothelial cells of blood vessels. Anything that have vessel association might have spindle-shaped cells. a. NF-1 b. NF-2 ~ Schwannoma (Antoni A) = Cutaneous neurofibroma ~ high cellularity (w/ palisading patterns with interspersing nuclear-free zones called Verocay bodies c. Leiomyoma (uterus & esophagus) d. Mesothelioma (cytokeratin positive) e. Anaplastic Thyroid cancer (biphasic & along with giant cells) f. Medullary Thyroid cancer (can also have polygonal cells) g. Primary cardiac angiosarcoma (malignant vascular spindle cells) h. Osteosarcoma (bone cancer) (pleomorphic cells) i. Meningioma j. Kaposi's Sarcoma (HHV-8) = Slit-like vascular spaces with plump spindle-shaped stromal cells +4  

 +1  upvote downvote
submitted by enbeemee(13),
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yhekcts ssya tath poa'ssik sha ntnailtiigrf tc,yosmyehlp so hwy wuodl gerla ggratseeag of alpiyact chlpymoytse be o?etcrcnir

titanesxvi  Bcz I think vascular is the key thing here, whereas atypical lynphocytes would be more of EBV +2  
d10s  the lymphocytes seen in kaposi sarcoma are not atypical. +3  

 +0  upvote downvote
submitted by amy(0),

HHV8 belongs to Herpesviridae family. Is it true that all members of this family have multinucleate cell with intranuclear inclusion body? HSV and VZV(cowry type A inclusion), EBV and CMV(owl-eye internuclear inclusion) certainly have them. Did anyone pick E for this reason?

Don't overthink this one. Kaposi sarcoma activates VEGF, so correct answer will refer to vessels. You sketchy peeps out there, think of the VEGF fertilizer with the red hose (representing vessel formation).

 -2  upvote downvote
submitted by d10s(1),

Kaposi sarcoma can sometimes be confused with bacillary angiomatosis, except in bacillary angiomatosis there will be neutrophilic infiltrate while in Kapsoi sarcoma it will be lymphocytic infiltrate.

 -6  upvote downvote
submitted by haliburton(192),
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saopik oma.crsa 8HVH. lvoiauseoc )pl(preu soni.sle ddaneavc VIH 4DC tl;& 002 WO(.)H

yotsubato  Yeah thats the easy part. But the histology is whats hard +