NBME 22 Answers : Block 4 : #18 = A 10-year-old girl has a slightly painful 2-mm ...

welcome redditors!

to snoo-finity ... and beyond!

NBME 22 Answers

nbme22/Block 4/Question#18

A 10-year-old girl has a slightly painful 2-mm ...

Granuloma

+11 upvote downvote
submitted by seagull(722),

The authors went out of their way to find thew worst photo of a granuloma they could. The threw on a stem that suggests that it would be granulation tisue. But little did we know...

amorah I was between granulation tissue and granuloma. Then ruled out granulation tissue because this is a 10 week old wound. Assuming normal wound healing, granulation tissue would be replaced by type III collagen/resolution by 10 weeks. +8

sbryant6 Got this right because the exact same question is in Uworld. +

dubywow Got baited... took my eye off the ball (and onto that worst photo ever) and missed the Ten week part. Granulation for the "L". +1

groovygrinch Anytime they go out of their way to mention sutures, my mind goes right to granulomas +

beto there are multinucleated cells(minimum 4). this helped me to choose granuloma over granulation tissue +

+3 upvote downvote
submitted by kard(15),

Might be this way, correct me please if my approach is mistaken. So in the Stem we have a Painful nodule, (Due to 10weeks ago Sutures) So im thinking on Suture granuloma, that forms a lesion (Painful Nodule) arround the non-absorbable suture material.

+1 upvote downvote
submitted by bobson150(4),

Is the grey supposed to be a suture? If not why would this not be wound healing therefore granulation tissue?

asapdoc If you look at the picture you can see the epithelioid and giant cells. I only picked granuloma because I remember seeing a similar picture in Uworld. +5

dentist granulation tissue is a part of the normal wound healing process, and happens within the first week. +

+0 upvote downvote
submitted by gubernaculum(1),

A suture granuloma essentially is a foreign body reaction to suture remaining in the tissue after surgery. It is generally a tender, erythematous nodule that occurs several days to weeks after surgery. A suture granuloma is treated with intralesional steroids or excision.

https://www.aafp.org/afp/2009/1215/p1483.html