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NBME 21 Answers

nbme21/Block 4/Question#2
A 23-year-old woman comes to the student ...
Obliterative endarteritis with lymphocytes and plasma cells🔍

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Syphilis pathogenesis is the inflammation and obliteration of the vasa vasorum (small blood vessels) that feeds bigger blood vessels like aorta, arteries, arterioles. It does not matter what the stage is, T. pallidum infects the vasa vasorum and, in the process, obliterates the nerves and blood vessels. This kills blood supply to those areas = ischemia but no pain (painless chancre). More localized in earlier stages, and in later stage, the spirochetes disseminate, so you have the aorta and spinal cord involvement but same pathogenesis. (Edit: Goljan explained this somewhere.)

privatejoker  So is the heavily implied step-wise formation of Syphilis symptoms as presented in FA complete BS then? Why break it down into stages and have us learn it as such if this is not the case in real practice? +3  
lilmonkey  Exactly, Goljan mentioned this in one of his audio lectures. All kinds of lesions in syphilis caused by vasculitis. +2  

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submitted by liltr(21),

It is syphilis. Syphilis is an endarteritis! :)

“The pathologic changes associated with syphilis are characterized by obliterative endarteritis that is found in all stages of the disease.”

 +0  upvote downvote
submitted by oznefu(10),

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.” +1  
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. +  

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