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NBME 23 Answers

nbme23/Block 1/Question#34
A 64-year-old woman is found dead at the foot ...
Metastatic breast cancer🔍

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 +9  upvote downvote
submitted by sajaqua1(384),

The single most important thing about this gross pathology is that the disease is multinodular. This indicates metastases from distant sites.

Liver abscesses are usualy singular, filled with creamy yellow pus, and may show a fibrous capsule. Cirrhosis often shows a yellow color due to fatty change as well as regenerative nodules, which are not present here. A focal nodular hyperplasia is a singular tumor of the liver, and this is multinodular. Hepatitis B is a little harder to distinguish because from what I can tell it can be multinodular in some cases, but this liver also shows none of the sclerosis from chronic inflammation that would likely accompany Hep B. Finally, we see no dark discoloration to indicate infarction.

monkd  It doesn't explain the sudden death, but I suppose they aren't asking for that! +2  
charcot_bouchard  I hate this type of ques. Here it is. Tell me what it is? +1  
divya  also, a liver infarct is unlikely due to rich dual blood supply. +  
drzed  @divya Rather, if there was an infarct, it will be hemorrhagic, not pale. +  
llamastep1  Multiple solid lesions on a healthy liver = meta. I assumed breast wouldn't meta to liver (it's usually GI cancers) but it makes sense since all the blood gets filtered by the liver at some point. TIL! +  

UW on FNH -pop: young women -mx: hepatic vascular deformity->localized hyperperfusion w/ secondary hyperplastic response -dx: small, solitary, pale nodule. central stellate scar w/ fibrous septae -sx: asymptomatic; discovered incidentally

+1/- almondbreeze(49),

 +2  upvote downvote
submitted by seagull(835),

at the very least, there are multiple areas of cancer giving some indication that it maybe metastatic.

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