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NBME 24 Answers

nbme24/Block 4/Question#35 (68.2 difficulty score)
An investigator is conducting a study of a ...
Basal keratinocyte:suprabasal keratinocyteπŸ”

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submitted by usmleuser007(377),
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fArte meos rheraces sith is why eth oreth rewsasn aer tir:noercc

aBsla ayinceteotkr amp&; nlmaia ilacud

  • Ioccnrret bc/ amlani dulcai si a moteconnp fo teh bsmteean mnbreaem hwhic is nfdou netweeb eth eeiphitmlu dan rgundnleyi ovencctnie uistes .(ge,. pimeerids nad esmdri fo het is)nk.
  • tI si a gyhrulo 04 tenmoaenr ediw tlclcnruno-eeet ozen ewteebn eht saplma emenbamr fo eth bslaa elcls dan the eecsodn(ee-l)nrt mailna aneds of eth setbname meabrn.em )K(WII
  • absal aecorytitken cetatahs ot eth mabesent anrbmeme nisgu oodmhmsseieem

uaanlGrr cyeknaoirtet &pma; amsttru onmruce

  • taruSmt cuidmlu artpasese hetes two .syeral
  • hreet aer on smoesdmoe atht entconc tsehe owt alysre
  • Iaegm rof eernferce

inaamL dlcaui mp&a; naiLam nadse -- lckci rfo gimea

  • otbh rae prta fo hte ntsabmee anrmeemb nda otn eth mrsideepi

Mayotnecle p&ma; sbala ckitrnyeeto --- click orf aemgi

  • rea both nctceoned to othcreae via icas-rdneEh
  • ti is lbarpoby eth eadgma to this eccontinon ttah
azibird  The stratum lucidum is only present in the thick skin of the palms, soles, and digits. So the stratum granulosum and corneum do touch in most of the body. I guess they just aren't connected by desmosomes. +  
peridot  Wow if I'm understanding this correct, lamina lucida (basement membrane) is not the same as stratum lucidum (between stratum corneum and stratum granulosum). That def confused me about this question bc I simultaneously was like wait isn't this in the basement membrane but also recalled the picture in FA with all the layers. Thanks so much for the super detailed explanation of all the answer choices! +1  

submitted by fenestrated(28),
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salacBiyl isnkga fi ouy nowk eihsgpuPm Vs.ragliu otrSenaiap of lsriupsbaara pdeisiem,r ttanic aslba oktecinaretys vs Bloosul i-e&hgop-tm;pidg ncsdulei arspteniao fo lsbaa yarle

subclaviansteele  This how I thought of the question...Classic histology photo of the "tomb stone" row of basal cells and the lifted keratinocytes. +2  

submitted by lsmarshall(396),
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"Demmoesos u(caMal hnseer)ad - A lleleo--ctcl teoocinnnc htat dperisov curtsaturl upsrotp whit dramieetinte sltnfia,em iyrlrptclaau ni stesisu atht rgudeno nlicheaamc ssrets ,.eg.( ksin, ricatsg uistse, rl)b.edad ncsCnoet eyrktictesaon in teh tuatmrs suospinm of het emeiidp".sr - SAOSBM

sympathetikey  This is why I was looking for some answer indicating keratinocytes in the stratum spinosum...instead they just gave a bunch of bs choices. +29  
roygbiv  I'm confused because I also know that S. aureus cleaves desmoglein in the stratum granulosum, so why is it specifically this answer? +2  
duat98  desomosomes connects cells to cells. hemidesmosome connects cells to basement membrane. +2  
medguru2295  I think what this is really asking is can you tell Pemphigus Vulgaris from Bullous Pemphigoid Vulgaris (question)- Attack on DESMOSOMES- this separates some keratinocytes from others (ie some in basal layer from ones above). Pemphigoid- attack on HEMIDESMOSOMES- this means separation of the keratinocytes from the basement membrane. +2  

I answered this question just knowing that desmosomes connect cell-to-cell so I chose the answer with the same cell type (keratinocyte to keratinocyte)

+7/- jgraham3(16),

submitted by brethren_md(88),
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itpduS ,tensqoui osnhtyel ujst ekta uory setb usseg dan voem no oll.

seagull  β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–ˆβ–€β–€β–‘β–‘β–ˆβ–‘β–‘β–‘β–‘β–‘β–‘ β–‘β–‘β–‘β–‘β–‘β–‘β–„β–€β–€β–€β–€β–‘β–‘β–‘β–‘β–‘β–ˆβ–„β–„β–‘β–‘β–‘β–‘ β–‘β–‘β–‘β–‘β–‘β–‘β–ˆβ–‘β–ˆβ–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–β–‘β–‘β–‘ ░░░░░░▐▐░░░░░░░░░▄░▐░░░ β–‘β–‘β–‘β–‘β–‘β–‘β–ˆβ–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–„β–€β–€β–‘β–β–‘β–‘β–‘ ░░░░▄▀░░░░░░░░▐░▄▄▀░░░░ β–‘β–‘β–„β–€β–‘β–‘β–‘β–β–‘β–‘β–‘β–‘β–‘β–ˆβ–„β–€β–‘β–β–‘β–‘β–‘β–‘β–‘ β–‘β–‘β–ˆβ–‘β–‘β–‘β–β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–„β–‘β–ˆβ–‘β–‘β–‘β–‘β–‘ β–‘β–‘β–‘β–ˆβ–„β–‘β–‘β–€β–„β–‘β–‘β–‘β–‘β–„β–€β–β–‘β–ˆβ–‘β–‘β–‘β–‘β–‘ β–‘β–‘β–‘β–ˆβ–β–€β–€β–€β–‘β–€β–€β–€β–€β–‘β–‘β–β–‘β–ˆβ–‘β–‘β–‘β–‘β–‘ β–‘β–‘β–β–ˆβ–β–„β–‘β–‘β–€β–‘β–‘β–‘β–‘β–‘β–‘β–β–‘β–ˆβ–„β–„β–‘β–‘β–‘ ░░░▀▀▄░░░░░░░░▄▐▄▄▄▀░░░ THis Question β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘ +2  

submitted by usmleuser007(377),
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etfrA mose eresachr htis is hwy the rothe rseswna ear rotrc:einc

  1. lsaba oaknieerctty p&a;m lianma ualicd
  2. trroIeccn bc/ limaan uidlca si a mncooenpt fo teh nbasteem emarbmne hwich is udfon bewetne eth piemlhtuie nda nleuydngir ocveienctn usiets ,g..(e epsiemird nad edsrim fo het .nkis)
  3. tI is a grulyoh 04 rnoeatmne ewdi -utleenceclotrn zneo eebewtn teh asmalp baenermm fo the asbla slcel nda eth ne(ed)solnter-ec maalin edsan of the tensemba e.ammernb )IWI(K
  4. lsbaa rtetnyiceoak etasacht to the anbteems rbneamem inusg mhiesmeosomed

  5. rualraGn ryeiocettkna m;&pa trsatmu oncrmeu

  6. atutrmS mcdliuu tsapeears hsete two e.yslra
  7. ethre era no emsdsomoe hatt ncnocte teesh owt lsayer
  8. emagI for refceenre

  9. Lmniaa duical ±a amianL adsen -- cikcl orf migea

  10. tboh rae ptra fo eth esatmneb benaemmr nda ton hte eimispdre

  11. ltMnoyaeec pa;m& sbala tycenoirtek --- clcki for maige

  12. are tobh tndoneecc to otehaerc iva iadr-Escneh
  13. ti is bloabrpy the gadame ot iths oocencnnti atth ihgtm dela ot amaemlon

submitted by misterdoctor69(40),

How come melanocytes:basal keratinocytes don't also have a desmosomal connection (in addition to their E-cadherin link)?

vivijujubebe  melanocyte is not part of the epidermal structure. they're at the epidermal-dermal junction and they produce melanin which is transported to the epidermal +  

submitted by usmleuser007(377),
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itBlrneisg sdiesesa shcu sa epshpugim rgavluis V(P) and phmusipeg isclfaueo PF() are eomiumautn edassies in hchiw tbooin-usiedaat ertagt osgeelsm.ndi

  • VP si sadeuc yb iinartuclgc aisebatntodoui g)I(G htat rtaget Dg3s mnis(Degeol 3) adn emsoesitm gDs.1
  • VP is naitmefdse yb alrabspuas aylssa,othcni or tibessrl ni hte oucmus rmeabmne nda lebrsist ni het sred.ieimp
  • FP ttiseapn vaeh ottnaadiiseubo taht rtteag sDg1 hitw pfcirelsuai ssbitrel no teh dsipmieer ihtw on muucso abmemenr es.usis
  • hotB sieadse rtseul in a lsos fo acioykernett nshaieod.
  • pumgeihsP nac soal eb acdseu yb a iecbtalar fnetiicno: solulub pgotemii is na nitfnoiec caudse by a oacoytcculpshs rtiabceum ahtt eleerssa a xotin tath celvase eht sD1g lrelaxreactlu .oaimdn

submitted by osgoodschlatter10(27),
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Dsmeesosom by itcnfnuo nneioecnrctt tyiceatsnrkoe in eth ratmstu nomspsui - uatmrts sunmosip si het aalubrpssa aeylr. dleEcxu paino ):to uiaLdc is oto ghhi ; ont ni ionctoaunint iwht aslba clea)ry rneuCom si vnee grh,hei osGraumunl dna norCemu erant' n ntciia )nodonut nLmaai ends (BM) and lnamia lcdiua otn cykoieertatns nda ont in innaniootuct rehit) ee ayeeltoMnc rea in the absla arel;y it si ton a tkeenctaiyor

b) is eht ynlo otiopn htta amsek snsee sdaeb on goyoliths nad oals het oynl opinot ahtt kpases buoat kt-tiyieetrnoraecn ianlekg

submitted by osgoodschlatter10(27),
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oDesosmsme yb outcinnf eeirtnnntocc ioynactterkes in eht rstmtau spounims - utarsmt msipsonu is hte ubapalassr er xeldcEu a:poit )on dLaciu is oto hihg ; tno ni noiotnnutcai tiwh aalsb cey)l ar ueonCmr is neev r,ighhe sGuanlumor adn eComurn 'rtnea n otnnncouit)id a Lanmai sned BM)( dan iaanml ilacdu ton iscoaettenryk adn otn ni ouantincotni h )eetrei eylMnaetco ear ni eht alabs lyre;a ti is tno a eatokeirntyc

b) is eth ylno tonipo ttha easkm ssnee absde no isootghly nda oasl eht lnyo piootn ttah kaspes boatu knerntceetoya-iirt leikang

submitted by ankistruggles(14),
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hyW si lbaas ceitrayneokt : abaarpsuls teoectairkny hte llec joiuntnc ahs’tt tmos elklyi ot eb fectfe?ad sI ti eaeucbs ’sti eht nlyo rsaewn that tssli a nncojuti nbeetew tow icakotyrtes?ne

sattanki  Not too sure on this one, but I interpreted the basal keartinocyte:suprabasal keratinocyte as the stratum spinosum region, which is known to have the most desmosomes. +