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NBME Free 120 Answers

free120/Block 1/Question#22 (reveal difficulty score)
A 35-year-old man comes to the physician ...
Separation of endothelial junctions ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

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 +6  upvote downvote
submitted by โˆ—bwdc(697)

Endothelial tight junctionsโ€™ permeability is increased in response to injury and inflammation, allowing migration of white blood cells and friends to the site of injury.

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jesusisking  Thank you! +1
focus  Ugh I was thrown off by "disruption of vascular basement membranes" since it seemed similar to the correct answer but I can see how "separation" would be a normal, expected response of the body that is needed vs. "disruption" would be traumatic and abnormal... please correct me if I am wrong! +2
blah  @focus reasoning sounds right. I nearly picked that but the other choice sounded better. Just semantics. +4
aakb  um just to clarify I don't think the differentiating factor is the wording of separation vs disruption. but rather that the correct answer is separation of ENDOTHELIAL junctions meaning that the spaces between the endothelial cells get wider. vs the answer youre thinking of says the disruption of the vascular BASEMENT MEMBRANE (which is under the endothelial cells) gets disrupted. so meaning something literally broken through the blood vessel and made a cut in the layer beneath the endothelial cells that line the blood vessel Dr. Sattar from pathoma usually draws a basement membrane and a layer of endothelial cells sitting on top +6

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submitted by โˆ—dixie96(3)

FA pg 213 (2019 version) says tumor AKA swelling is due to endothelial contraction/DISRUPTION so i thin this is what they were getting at

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submitted by โˆ—kms123(2)

can someone explain why it's not degranulation of eosinophils?

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fhegedus  Eosinophils (FA 2020 page 408) are involved in type I hypersensitivity reactions (asthma, allergy, analphylaxis), parasitic infections and other pathologies. They are not involved in edema formation. I hope this helps! :) +
fhegedus  Also, the patient in the question got a laceration, which probably led to a bacterial infection; so neutrophils would be predominant, not eosinophils. +

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