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NBME 22 Answers

nbme22/Block 3/Question#45 (55.2 difficulty score)
A 28-year-old man who is seropositive for HIV ...
Slit-like vascular spaces with plump spindle-shaped stromal cells🔍

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submitted by usmleuser007(370),
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ym tils of sinpled eypt lecls dan niosc:tndio

  • a. -N1F
  • b. F-2N ~ nachSwanom niot(nA )A = nCuoaeust rfabreomonui ~ high ituylcrella /w( ipslaandig taternsp iwth esipngriersnt acfee-relunr nzseo b;&rsldacyVepolcaen sbeodi
  • .c mmeyLoioa (uuesrt &p;am ehaspou)sg
  • .d Mhaoloeemsti aite(ytrncok ovep)siit
  • e. Aacaplitsn ihdroTy eacnrc chbsiai(p &;pma aglno itwh tanig c)lsel
  • .f Mrullyead dyirhoT carenc cna( laso eahv ypolgnloa )lsecl
  • .g ayrPrmi radcaci gsicoaamnaor giaaltnm(n cluravsa ipnleds llec)s
  • h. samtaoOoscre ebn(o nae)crc ropophieml(c cell)s
  • .i ieimonMgan
  • .j ssiopK'a cmaarSo -(H8)VH = lkSelti-i avscaulr psesca tihw plupm e-hpdlsaseindp tlsmrao llsec
drdoom  @usmleuser007 to make lists display correctly, try using the plus sign (+) for each "bullet point"; that should work +1  
mcl  I love this and I love you +4  
usmleuser007  LOL thanks, had to ddo a lot of digging since "spindle cells" are commonly tested +3  
leaf_house  @uslmeuser007 "MAMML PONNK" is the best I can do with that +  

submitted by drzed(206),

(A) aggregates of large atypical lymphocytes = infectious mononucleosis (CD8+ T cells responding to EBV infection in CD21+ B cells)

(B) Granulation tissue containing pseudohyphae and budding yeasts = candidiasis

(C) Intracellular yeasts in macrophages = histoplasmosis

(D) Macrophages containing acid-fast bacilli = mycobacterium

(E) Multinuclear cells containing intranuclear inclusions = cytomegalovirus (or most members of the herpesvirus family)

submitted by mcl(578),
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To eadnxp no i,hts ehsgouotntypilaol sbicderes eth hyoilsogt fo kasopiw sracaom as snepli"d elscl onifmgr tslis htwi adtrtxvseaae edr bdolo c"lels

mcl  lul i don't know why i spell kaposi like that, my b +10  
bubbles  This site is super helpful. Thanks for sharing :) +  
mcl  yesssssss ofc <3 I love path outlines +  
usmleuser007  Just realize that spindle cells are similar to the endothelial cells of blood vessels. Anything that have vessel association might have spindle-shaped cells. a. NF-1 b. NF-2 ~ Schwannoma (Antoni A) = Cutaneous neurofibroma ~ high cellularity (w/ palisading patterns with interspersing nuclear-free zones called Verocay bodies c. Leiomyoma (uterus & esophagus) d. Mesothelioma (cytokeratin positive) e. Anaplastic Thyroid cancer (biphasic & along with giant cells) f. Medullary Thyroid cancer (can also have polygonal cells) g. Primary cardiac angiosarcoma (malignant vascular spindle cells) h. Osteosarcoma (bone cancer) (pleomorphic cells) i. Meningioma j. Kaposi's Sarcoma (HHV-8) = Slit-like vascular spaces with plump spindle-shaped stromal cells +5  

submitted by enbeemee(13),
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ykthsec ysas ttah sapi'sko ahs nntflagiitri toyhlp,csyem os why wdulo elrga gaeetsgrga of alpytica shyytpemocl eb oe?irnrctc

titanesxvi  Bcz I think vascular is the key thing here, whereas atypical lynphocytes would be more of EBV +2  
d10s  the lymphocytes seen in kaposi sarcoma are not atypical. +3  

submitted by amy(0),

HHV8 belongs to Herpesviridae family. Is it true that all members of this family have multinucleate cell with intranuclear inclusion body? HSV and VZV(cowry type A inclusion), EBV and CMV(owl-eye internuclear inclusion) certainly have them. Did anyone pick E for this reason?

submitted by jessikasanz(4),

Don't overthink this one. Kaposi sarcoma activates VEGF, so correct answer will refer to vessels. You sketchy peeps out there, think of the VEGF fertilizer with the red hose (representing vessel formation).

submitted by d10s(1),

Kaposi sarcoma can sometimes be confused with bacillary angiomatosis, except in bacillary angiomatosis there will be neutrophilic infiltrate while in Kapsoi sarcoma it will be lymphocytic infiltrate.

submitted by mdmikek89(0),

Spindle cells....sarcoma or carcinoma

Kaposi *Sarcoma*...

Why y'all make this shit so complicated?

drdoom  This explanation only begs the question. (It's a tautology.) +1  

submitted by haliburton(208),
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oisapk ar.caoms H.V8H lviaousoec ul(pp)re soeslin. vadcdaen HVI 4DC ;l&t 020 HOW().

yotsubato  Yeah thats the easy part. But the histology is whats hard +