NBME 16 Area labeled by the letter 'B' (NBME Answers)

Retired NBME 16 Answers

nbme16/Block 4/Question#35 (reveal difficulty score)
A 51-year-old woman comes to the physician ...
Area labeled by the letter 'B' 🔍 / 📺 / 🌳 / 📖
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submitted by ∗bingcentipede(359)

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Good explanation on reddit: https://www.reddit.com/r/step1/comments/d8aqj5/spoiler_nbme_16_hey_can_anybody_advice_how_to_get/

Essentially, A = mucinous glands (foamy cytoplasm) B = parietal cells (stain eosinophilc, P ar I etal cells stain PInk w/ a fried egg appearance. Additionally, they're above chief cells C = chief cells (stain basophilic, super dark, and below parietal cells)

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md_caffeiner reddit: Its not about histology knowledge, you just need to know two things about parietal cells - they are eosinophilic on histo and they are located more superficially compared to chief cells (super basophilic, labeled as C). If you know chief cells are C, mucinous glands are A due to the foamy cytoplasm, the answer has to be B. +

md_caffeiner reddit2#You're exactly right (although I would say it is histology knowledge). Gastrin stimulates both parietal and chief cells but only parietal cells release hydrogen ions (and chloride ions - to make HCl). ArtiomK is right about the staining and location of parietal cells being highly acidophilic (pink) and predominantly at the apical part of the gastric gland - they're often described as having a fried egg type of appearance (big, round cytoplasm [egg white] with a central, round [yolk] nucleus). Chief cells produce pepsinogen (enzyme) so display the basal basophilic (purple) staining and they're found predominantly at the base of the gastric gland. So, it's a mix of theory and practical understanding - knowing the structure and function of the gastric gland and then the practical histology of the gland (and its cellular composition). +1

md_caffeiner dont go to reddit and get distracted for 15 minutes lol +14

deberawr it's better than redownloading tiktok and getting distracted for 3 hours lol (don't do what i did its embarrassing) +

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submitted by stevenorange(6)

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first should know that this is the fundus or body of the gastric, so it should be the parietal cell domaine; then think the mucus is the protective one , A without hesitate. then the other on the upper glandular layer should be the paretal cell, which is B. others like C is so small ,in the deeper glandular layer and basalphilic looking maybe is the chief cell . then deeper could be the submucosa layer. UW ID124 fyi.

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zme331 ???? +

tyrionwill how would I know where is superficial and where is the deep layer? +

sexymexican888 @tyrionwill if you look at D and E they look more like muscular tissue than glandular tissue (like A,B,C) so thats how you can orient yourself and know that the bottom layer is by D and E so A must be more superficial. +

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submitted by ∗zincy7(29)

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Burning Abdominal Pain that occurs hours after eating = Gastric Ulcer
Sweating profusely and orthostatic hypotension
Epigastric tenderness
2-cm mass = most likely a GASTRINOMA\

This is confirmed by the question stating the tumor cells release gastrin but requires you to understand what parietal cells and basic gastric mucosal histology looks like

REFERENCE: ZOLLINGER-ELLISON SYNDROME

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