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NBME 23 Answers

nbme23/Block 1/Question#29 (38.9 difficulty score)
A 34-year-old woman with a 5-year history of ...
Infiltration of lymphocytes, plasma cells, and macrophagesπŸ”
tags: immuno 

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 +3 
submitted by docred123(6),
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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. +42  
almondbreeze  Fa2019 pg 215, 217 on acute/chronic inflammation +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? +  
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? +  

FA 2019 page 172.

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