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Contributor score: 6

Comments ...

 +0  (nbme21#12)

I picked Crohn’s too. I think the severe constipation over 5 years distracted me.

haliburton  i think it is critical to remember that constipation is what caused the diverticulosis.

 +6  (nbme21#24)

It’s acute alcohol consumption so fatty change more likely. Cellular swelling indicates alcoholic hepatitis which requires chronic alcohol consumption (See FA 2019 pg 385). At least that’s the logic I used to pick fatty change.

seagull  Seems like fatty change would require more than 1 weekend. I choose swelling since it's reversible and seems like something with a quick onset.
nc1992  I think it's just a bad question. It should be "on weekends"
uslme123  So his hepatocytes aren't dying ( ballon degeneration ) vs just damaged/increased FA synthesis due to increased NADH/citrate
sympathetikey  @seagull I agree!
et-tu-bromocriptine  It's not in pathoma, but I have it written in (so he or Dr. Ryan may have mentioned it) - Alcoholic hepatitis is generally seen in binge drinkers WITH A LONG HISTORY OF CONSUMPTION.

Subcomments ...

submitted by oznefu(7),

Could anyone give an example of what diseases would best match the other answer choices?

vonhippelindau  Leprosy is a noncaseating granuloma fyi. I found that granuloma with suppuration can be caused by blastomycosis according to Robbins (pg 710): “In the normal host, the lung lesions of blastomycosis are suppurative granulomas. Macrophages have a limited ability to ingest and kill B. dermatitidis, and the persistence of the yeast cells leads to continued recruitment of neutrophils. In tissue, B. dermatitidis is a round, 5- to 15-μm yeast cell that divides by broad-based budding. It has a thick, double-contoured cell wall, and visible nuclei (Fig. 15-38). Involvement of the skin and larynx is associated with marked epithelial hyperplasia, which may be mistaken for squamous cell carcinoma.” +  
usmleuser007  Pyogranulomatous Inflammation An inflammatory process in which there is infiltration of polymorphonuclear cells into a more chronic area of inflammation characterized by mononuclear cells, macrophages, lymphocytes and possibly plasma cells. Actinomyces sp. is gram-positive, acid-fast–negative filamentous bacteria that cause pyogranulomatous infections in dogs, cats, cattle, goats, swine, horses, foxes and human beings. +