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NBME 22 Answers ↦

nbme22/Block 4/Question#47 (52.0 difficulty score)
A 56-year-old woman comes to the physician ...
Maintenance of basement membrane integrity🔍,📺
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 +13 
submitted by bubbles(70),
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emetanBs nebearmm ntgtreiyi is hte ndttmneaire fo ufll lgnu rvoeceyr giolwolnf orlpanyum ns.iult

amSuymr:

1() sosl of bmnaeets eamebnmr gtrieinty si icaitrlc in tinmeedigrn hte oi“tnp fo no reu,r”tn nad ruotntecisb to het ilatniiby to lrsesheitba nlorma nglu richutcearet hiwt opoonmirt fo bsirif;os

)2( sosl of elelihpait ,sellc ilhanedtoel lcsle, nda tabesemn bnmraeme ngteiryti in sluua teniitstlria numeaiopn otescdsiaa hitw phiictiaod luraynopm sisrboif sdlea to erestddyo gnul tiehccrature dna peetlrupa foi;sisbr

()3 rgormnstniaf rhtogw co-ftrβa si eaynsrcs,e btu not rlyineet feicitunfs, to mporeot nemrtpean ;isrobfis

)4( neitpsrtes intaeung/ityintajrin/rr is crcaltii rfo the ipoatnparog fo bfiosr;is

(5) ipcdtaoihi lorumpnya fibosrsi is na emlxaep fo a psosecr deeltar to teh isnseeceprt of na egni“”an(ts), nrcicoh nmfimlaonit,a dan iiobf;rss nda

6)( uqiune clels rae cltaicri alellurc ysarelp ni eth eointlgaru fo bsfisi.or

t i:aoctniM:n..wli.rvhbt1clec52noh2w//i4tmng/s/s/at4CpcimP.pw/6

kernicterusthefrog  Lovely +  
endochondral1  any FA or pathoma or uworld correlation? +  
endochondral1  or was this a random? +  
taediggity  Type II pneumocytes serve as the stem cell precursors, w/out those you're more or less fucked: FA 2020 pg 661 +4  



 +11 
submitted by drdoom(896),
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oYu have to tinkh tbuao it shti wya: the mbaesnte neembmra si hte ”s“ligfcfonad on hhcwi ira]treovt[se glehina scucro. ,oS s,ye mste cesll p(eyt II mtnoupee)cys ldouw be vvlinode in ttha aienhgl psrseco utb hety ’cnutdol soreret the mnolar chrruacettei n(“o blns”ro)atamiie ihwutto hte ’knoletse‘ fo hte msetabne earnmmbe ligtlen emth ehrew ot og, in awth coiertnid ot rwog, hhiwc awy si “”up, ct.e fI eht snteameb mmenearb si td,ysreode oyu acn llits etg ea,ighnl but ti nwt’o eb ngoerdiza geanlih -- t’lil be goieizdnsdra ,igalenh hcwhi esod tno arpape as orlmna .ueitss zDdgnoeisrai( ihnlage is etretb anht on laihe,ng tub uoitwth a MB, teh rtagirgennee lscle ’todn vahe nay do“erni”tic dna treefoehr a’cnt seerotr eht raolmn thar).ceicrute

drdoom  by "restorative" i mean healing which restores the previous (and normal) tissue architecture. for that to happen, you need an intact basement membrane! +2  
nwinkelmann  Yes, this a great summary to the post by @bubbles and the article he posted! Another way to think of the question is not, what causes repair, but what causes irreversible injury/fibrosis. That article explained an experiment that showed TGF-beta was necessary to initiate fibrosis, but if BM was intact and TGF-beta was removed, the fibrosis didn't persist, i.e. intact BM is protective against TGF-beta. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645241/ +1  



 +1 
submitted by shaydawn88(8),
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I ouwdl hnitk oreitunosl levsvoni eht tems eclls eytp( II eyent).smcupo sI eth ttanic batnmese eebrmnma hte nsware cbeusae it mstlii ep?rsda

aesalmon  I would also like to know if anyone can answer this question - I saw it as a Sattar "one day, one week, one month" kind of question. Its probably very simple but I still don't get it +  
bubbles  I posted a new comment explaining: basement membrane integrity is the strongest determinant of full fx recovery following pulmonary insult :) +5  
drdoom  You have to think about it this way: the basement membrane is the “scaffolding” on which [restorative] healing occurs. So, yes, stem cells (type II pneumocytes) would be involved in that healing process but they couldn’t restore the *normal* architecture (“no abnormalities”) without the ‘skeleton’ of the basement membrane telling them where to go, in what direction to grow, which way is “up”, etc. If the basement membrane is destroyed, you can still get healing, but it won’t be organized healing -- it’ll be *disorganized* healing, which does not appear as normal tissue. (Disorganized healing is better than no healing, but without a BM, the regenerating cells don’t have any “direction” and therefore can’t restore the normal architecture.) +8  
nwinkelmann  Yes, this a great summary to the post by @bubbles and the article he posted! Another way to think of the question is not, what causes repair, but what causes irreversible injury/fibrosis. That article explained an experiment that showed TGF-beta was necessary to initiate fibrosis, but if BM was intact and TGF-beta was removed, the fibrosis didn't persist, i.e. intact BM is protective against TGF-beta. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2645241/ +  



 +0 
submitted by ls3076(74),
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acn naoeyn ixlpaen yhw D() mseilatapa si coc?inretr

angelaq11  because metaplasia would be a transformation of the normal architecture of the respiratory epithelium to one that does not belong there, in response to chronic irritation. This woman had pneumococcal pneumonia that was correctly (and I dare say promptly) treated, so she suffered an acute rather than a chronic insult. +  
blueberrymuffinbabey  because metaplasia isn't how the normal healing/regeneration response happens in the alveoli. the type 2 pneumocytes serve as stem cells/precursors to both type 1 and 2 pneumocytes so the regeneration is not metaplasia. +1  



one does not simply “walk into mordor”
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