NBME 22 Granuloma (NBME Answers)

Retired NBME 22 Answers

nbme22/Block 4/Question#18 (reveal difficulty score)
A 10-year-old girl has a slightly painful ...
Granuloma 🔍 / 📺 / 🌳 / 📖
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+25 upvote downvote
submitted by ∗seagull(1933)

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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...

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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. +21

sbryant6 Got this right because the exact same question is in Uworld. +1

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 +1

beto there are multinucleated cells(minimum 4). this helped me to choose granuloma over granulation tissue +6

haniainabox Also - pathoma pg 21 (ch.2), granulation tissue consists of fibroblasts, CAPILLARIES, and myofibroblasts, so I think with granulation tissue you'd see a lot more BV and blood +1

athenathefirst You can also see the giant cells-->Granuloma +

+6 upvote downvote
submitted by ∗kard(52)

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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.

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+5 upvote downvote
submitted by gubernaculum(11)

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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

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+1 upvote downvote
submitted by ∗bobson150(28)

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

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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. +

castlblack I agree I looked at that grey blob and thought foreign body --> granuloma +

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