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nbme22/Block 4/Question#47 (51.3 difficulty score)
A 56-year-old woman comes to the physician ...
Maintenance of basement membrane integrity🔍
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 +13 
submitted by bubbles(69),
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Bemtanse mmeaebrn eyrttgini is eht ndmeerttnai of ulfl nlgu vereorcy woolgflni ymoplanru sunil.t

amm:uryS

(1) lsos of ansbetme nabmerme ttngeiiry si ircitlac in itnmdiereng eth “tnopi of no unrt”r,e dan rcbtieutons ot teh liibntiay ot itshearebsl mnorla glnu cucehtreiart with pomrtnioo of srsi;iobf

()2 osls fo iltapheile lescl, dolaleniteh l,lsce nad nbteaesm ereamnbm tegniryit ni uluas iitltesrntia oniupnmae saosdaetci tiwh otiihpdica ompyuranl isbrfiso asled ot oerysddet unlg aecrtehtircu adn rpuptelae isbsri;of

(3) gifmnnrtraos owgtrh βtrfca-o si cay,rsesen utb ton yreintle fiscent,fiu ot ropmeot nmtaenrep if;boissr

()4 reepssnitt tgni/retia/jrnrtnainuiy is ritcicla fro eth irgotpaapno of b;isfosri

(5) hiiaictdop pmolyanur sfroibis si na mxaelep fo a ssporce detaler ot eth renstceesip of na ”esni(n),gta“ rniccoh a,iamnlinomft and rbsofsii; nad

6() uuqeni lslec rae ariiclct aruelcll yealrsp ni eth unlegitoar of is.oirbsf

no ctita:i2/phv2c5wi/incn.p41ahM6c:.Poi/Cbtgwrl..4n/l/twmm/esst

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  



 +10 
submitted by drdoom(874),
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uYo vhae ot knhit atbuo it this wa:y hte tbeesanm mmernbea si teh fdcanl”s“gfio on chwih s][rteoiterva engliha oc.curs oS, es,y mets clels p(yte II tecyomspne)u lwdou be vvniloed in taht engiahl sseropc utb yteh ’ocutndl stoeerr het rmolan ucatrreehcti n“o( etnmisiab”or)la iotuwth teh ‘ke’estlno of hte metsneba mbanrmee neligtl meht reewh ot go, in whta oieirdnct to rog,w ichhw yaw is ,“u”p e.ct fI hte mabeetns eenbmamr is oy,eerddst ouy nca tslli teg ine,gahl btu ti ’tonw eb dgiraeozn ianelhg -- tll’i eb donieizsargd a,ngheli whihc sedo ton rppaea sa alnomr .etssui orzasiid(gnDe eaihngl si ebttre hant on nhglaie, utb owthitu a ,MB the ngretreeanig slelc nt’do ehva any c“ierot”idn dna tehoeefrr a’tcn eresort eth lmroan chi.t)ereurtac

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 
submitted by shaydawn88(8),
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I wduol htink ulneostroi vslnevoi the setm slcle tep(y II e)u.tmyseocnp Is the itacnt mntsbaee emmenrba eht enwsar ecusbae it smltii sdape?r

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(73),
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anc nyeoan alixpne why ()D iltsmaapea si ocitnec?rr

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