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Retired NBME 16 Answers

nbme16/Block 3/Question#6 (reveal difficulty score)
A 51-year-old man with a 3-month history of ...
Segmental ischemic necrosis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—cassdawg(1781)
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Polyarteritis nodosa is a medium vessel vasculitis associated with different stages of transmural inflammation with fibrinoid necrosis of vessels. [FA2020 p314]

Because this is a vasculitis that affects medium vessels, it can affect the arteries supplying the muscles and thus cause segmental ischemic necrosis from loss of blood supply.

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radzio1  I thought that segmental is a key word for Burgers dz. +1
radzio1  *Buerger +
feochromocytoma  Beurger is characterized by segmental thrombosis with nerve involvement. +3
cheesetouch  So he has both PAN and Buerger's? +
pakimd  polyarteritis nodosa is characterized by segmental (different stages) of transmural inflammation with fibrinoid necrosis causing narrowing of vessel lumen and increased risk of thrombosis leading to tissue ischemia/infarction FA2020 pg314 +
shieldmaiden  The problem in Buerger is segmental thrombosis while PAN is ischemia from immune complexes with hepatitis antigens and it is also segmental (a string of pearls) +



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submitted by taylor5479(6)
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PAN is a vasculitis that affects medium sized vessels, which play a large role in the blood supply of muscles. The transmural inflammation and fibrinoid necrosis of the vessels can lead to an interrupted blood supply and ischemic necrosis in the muscles. The necrosis would be segmental since other parts of the muscle are still perfused.

Correct me if I'm wrong, but you can rule out the other answers simply because they are more related to glycogen storage diseases and similar metabolic etiologies. Segmental ischemic necrosis is pretty much the only answer available that could be caused by a vascular lesion of any kind.

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