NBME 24 Granulation tissue (NBME Answers)

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Retired NBME 24 Answers

nbme24/Block 2/Question#20 (reveal difficulty score)
A 52-year-old man is admitted to the hospital ...
Granulation tissue 🔍 / 📺 / 🌳 / 📖
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submitted by ∗fallenistand(27)

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Since you see vascularity that is why it is granulation tissue. Fibrous scar would be 1 month after and you wouldn't see that much blood.

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dentist The v-fib/death is an attempt to throw you off. The simple way of asking this question would have been: "18 days after an MI, you should see____?" +5

gubernaculum i would use pathoma for this. it says 1-3 weeks after an MI you can see granulation tissue +2

according to UWORLD in Day 10-14 there is granulation tissue , 2 weeks to 2 months there's collagen deposition and scar formation , so good luck to pick up 18 days

+8/- usmlecrasherss(27)

Pic from Robbins for the visual learners:

https://i.imgur.com/A4NK6ZD.png

+1/- hungrybox(1277)

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submitted by ∗impostersyndromel1000(42)

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Jokes on me, I pay $60 for NBME to tell me granulation tissue exists 18 days after infarct but UWORLD and AMBOSS say 3-14 days after infarct for granulation tissue and 2 weeks to several months for scar formation.

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submitted by ∗medstruggle(21)

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Why is the answer “granulation tissue”? I thought after 14 days you have a fully formed scar.

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colonelred_ If you go back and look at the image you can see that it was highly vascular which is characteristic of granulation tissue. Scar tissue formation will be closer to 1 month, plus you will see lots of fibrosis on histology. +15

sympathetikey It's a bit misleading, for me, since you do see fibrosis intermixed with the granulation tissue, but granulation tissue was a better answer. +2

haliburton According to FA 2017: 3-14d: Macrophages, then granulation tissue at margins. 2wk to several months: Contracted scar complete. Dressler syndrome, HF, arrhythmias, true ventricular aneurysm (risk of mural thrombus). i'm getting pretty frustrated with NBME contradictions to FA, and FA omissions of content. this stuff is hard enough to get straight as it is. +1

yotsubato Thats cause the NBME exam writers read FA, then make questions not fit in with FA +7

trichotillomaniac This fits the timeline laid out in Pathoma! 1-3 wks = granulation tissue with plump fibroblasts, collagen, and blood vessels +10

alimd never look at the image in the beginning. They dont want you to success. Most of the time images are made to ditract +1

jj375 In case anyone is like me and needs photos for the histology. 1)https://classconnection.s3.amazonaws.com/24/flashcards/1730024/png/mi1345149027193-thumb400.png 2) https://www.researchgate.net/profile/Charles_Murry/publication/7741771/figure/fig3/AS:280340762513421@1443849854598/Histological-stages-of-myocardial-infarction.png 3) https://slideplayer.com/slide/10661050/36/images/13/MI-+Microscopic+features.jpg +1

garble UWorld also has a handy chart for post-MI that said granulation tissue at 10-14 days, then collagen and scar tissue at 2-weeks to months /shrug +

Myocardial scar tissue for comparison. Note the intense fibrous deposits.

https://qph.fs.quoracdn.net/main-qimg-42289763352d6f33a5f6f8952cb857e7

+3/- peqmd(75)

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