NBME 20 Multinucleated giant cells and neutrophil infiltrates (NBME Answers)

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Retired NBME 20 Answers

nbme20/Block 1/Question#21 (reveal difficulty score)
A 75-year-old woman comes to the physician ...
Multinucleated giant cells and neutrophil infiltrates 🔍 / 📺 / 🌳 / 📖
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submitted by ∗hayayah(1212)

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This is an example of Shingles. Herpes simplex and herpes zoster viruses cause abnormal cell division in epidermal cells, and this creates multinucleated giant cells.

A Tzank smear showing multinucleated giant cells is characteristic of Varicella Zoster Virus infections. (HSV will have similar findings).

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ergogenic22 other identifying terms for herpes: Single dermatome (does not cross the midline), painful (burning and itching),and lesions in multiple stages. +3

redvelvet and why neutrophile infiltration, is it a thing? or just a distracting thing? +2

charcot_bouchard Neutrophil comes into party always first. but it was distracting for me too. +7

dulxy071 Regardless if it can help resolve the issue, neutrophil will always be the first responder +3

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submitted by ∗victor_abdullatif(10)

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Branching fungal hyphae without yeast forms = probably Sporotrichosis / Sporothrix schenckii

Diffuse separation of dermis and epidermis = Stevens-johnson / TEN

Granular depositis of IgA at the tips of dermal papillae = dermatitis herpetiformis

Immunofluorescent staining for C3 along the epidermal basement membrane = bullous pemphigoid

Nonbranching fungal hyphae with abundant yeast forms = ? (maybe tinea?)

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submitted by andremosq(9)

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HSV identification FA20. 166 Tzanck smear - Multinucleated giant cel, but PCR is the test of choice. Picture here https://healthjade.net/tzanck-test/

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