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NBME 23 Answers

nbme23/Block 1/Question#29 (reveal difficulty score)
A 34-year-old woman with a 5-year history of ...
Infiltration of lymphocytes, plasma cells, and macrophages ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: immuno

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submitted by docred123(9)
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Can anyone further explain this?! I could eliminate a few item choices and I guessed correctly, just need more information! Thanks

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wired-in  Patient has 5 yr h/o hep C, so it is chronic. Chronic inflammation is characterized by presence of lymphocytes & plasma cells while neutrophils is more characteristic of acute inflammation (Pathoma Ch. 2). AFP is within reference range so probably not HCC. Choice D, palisading lymphocytes & giant cells suggests granuloma which isn't typical of hep C. +51
almondbreeze  Fa2019 pg 215, 217 on acute/chronic inflammation +2
popofo  But doesn't AFP has not-so-high sensitivity for hepatocellular carcinoma (HCC)? If so, a negative result shouldn't be able to rule out HCC? +1
popofo  But doesn't AFP has not-so-high sensitivity for hepatocellular carcinoma (HCC)? If so, a negative result shouldn't be able to rule out HCC? +1
fatboyslim  HCC from hepatitis C usually takes decades to occur. This patient has only had HCV infection for 5 yeats +1
portland2020  typically you would have a monocytic inflammatory infiltrate as described. The monocytes are an important component of the innate response. The monocytes can differentiate into macrophages. +



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submitted by โˆ—weirdmed51(30)
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HCV : lymphocytic aggregation + macrovesicular steatosis FA 2019- p.172

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