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NBME 24 Answers

nbme24/Block 4/Question#35 (67.5 difficulty score)
An investigator is conducting a study of a ...
Basal keratinocyte:suprabasal keratinocyteπŸ”

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submitted by usmleuser007(370),
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teArf emso hcaerres hsti si hwy eth ehtor rssnewa aer oeci:tncrr

Balas attkeirynoce p;&am aainlm dlauic

  • ernorccIt bc/ aanmil uiadlc is a ectoponmn of eth embestan rnmmbeea hwhic is fuodn wbteene eht piemuehitl nad yndrluneig ientneoccv seistu ,g.(.e ediimpesr dna mdirse fo the n)ks.i
  • It is a royhglu 04 tnanereom weid cr-lnuteeneotlc ozne ebnteew hte lsaapm mbarnmee fo eth sabal sllce adn the -celedree()tnson amlina desan of the estbanem mbnr.aeme II)WK(
  • blasa ykenattroice cehtatsa to het etmbsaen aeernmmb insug smieheodmesom

arGrnual tantekircyeo ;pam& rtastum cmeurno

  • urSamtt imuudcl sestpeaar seteh owt rl.ysea
  • ehret rae on osdosmeme ttah onnccte etehs wot ryaesl
  • mIage fro rrefecene

Lanami ludiac mp;a& aniLma dsena -- cilkc ofr agime

  • tboh rea aptr fo eth matsebne eabmemrn nad otn eht miserpide

nMtelyoace pm&;a slaba ettroykneci --- kcicl ofr eigam

  • ear hbot dotnnccee to eaetcorh avi rdhe-naEcis
  • ti si bapobyrl hte egmada to shit nncoiotenc ttha
azibird  The stratum lucidum is only present in the thick skin of the palms, soles, and digits. So the stratum granulosum and corneum do touch in most of the body. I guess they just aren't connected by desmosomes. +  
peridot  Wow if I'm understanding this correct, lamina lucida (basement membrane) is not the same as stratum lucidum (between stratum corneum and stratum granulosum). That def confused me about this question bc I simultaneously was like wait isn't this in the basement membrane but also recalled the picture in FA with all the layers. Thanks so much for the super detailed explanation of all the answer choices! +1  

submitted by fenestrated(27),
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iaylBalcs ngiksa fi you wkon gmiePuhsp a.iurlgVs prnteoSiaa of uairrlbspsaa dsm,eeipir intcta basal eotyickretsna sv osluoBl &t-hmgpdpg;-ioei enuidscl peitaarsno fo lsaab yearl

subclaviansteele  This how I thought of the question...Classic histology photo of the "tomb stone" row of basal cells and the lifted keratinocytes. +2  

submitted by lsmarshall(392),
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"moessmoeD ulMaa(c a)dhnerse - A t--ceeloclll cinoncteno that pdroesiv trrauscltu rsuppto whti aeeieitrdtmn mtilsna,fe rypicultaarl in tseiuss atht orgduen aclhinaecm rstses .eg(,. ki,ns scartig siu,ste rdeda.b)l nnostecC tnickyotraese in teh astmtur spmuison fo eht derp"esii.m - SOSMAB

sympathetikey  This is why I was looking for some answer indicating keratinocytes in the stratum spinosum...instead they just gave a bunch of bs choices. +29  
roygbiv  I'm confused because I also know that S. aureus cleaves desmoglein in the stratum granulosum, so why is it specifically this answer? +2  
duat98  desomosomes connects cells to cells. hemidesmosome connects cells to basement membrane. +2  
medguru2295  I think what this is really asking is can you tell Pemphigus Vulgaris from Bullous Pemphigoid Vulgaris (question)- Attack on DESMOSOMES- this separates some keratinocytes from others (ie some in basal layer from ones above). Pemphigoid- attack on HEMIDESMOSOMES- this means separation of the keratinocytes from the basement membrane. +2  

I answered this question just knowing that desmosomes connect cell-to-cell so I chose the answer with the same cell type (keratinocyte to keratinocyte)

+6/- jgraham3(13),

submitted by brethren_md(87),
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Spditu eoiqu,stn hteonyls jstu keta uoyr bste gusse nad emvo on lo.l

seagull  β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–ˆβ–€β–€β–‘β–‘β–ˆβ–‘β–‘β–‘β–‘β–‘β–‘ β–‘β–‘β–‘β–‘β–‘β–‘β–„β–€β–€β–€β–€β–‘β–‘β–‘β–‘β–‘β–ˆβ–„β–„β–‘β–‘β–‘β–‘ β–‘β–‘β–‘β–‘β–‘β–‘β–ˆβ–‘β–ˆβ–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–β–‘β–‘β–‘ ░░░░░░▐▐░░░░░░░░░▄░▐░░░ β–‘β–‘β–‘β–‘β–‘β–‘β–ˆβ–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–„β–€β–€β–‘β–β–‘β–‘β–‘ ░░░░▄▀░░░░░░░░▐░▄▄▀░░░░ β–‘β–‘β–„β–€β–‘β–‘β–‘β–β–‘β–‘β–‘β–‘β–‘β–ˆβ–„β–€β–‘β–β–‘β–‘β–‘β–‘β–‘ β–‘β–‘β–ˆβ–‘β–‘β–‘β–β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–„β–‘β–ˆβ–‘β–‘β–‘β–‘β–‘ β–‘β–‘β–‘β–ˆβ–„β–‘β–‘β–€β–„β–‘β–‘β–‘β–‘β–„β–€β–β–‘β–ˆβ–‘β–‘β–‘β–‘β–‘ β–‘β–‘β–‘β–ˆβ–β–€β–€β–€β–‘β–€β–€β–€β–€β–‘β–‘β–β–‘β–ˆβ–‘β–‘β–‘β–‘β–‘ β–‘β–‘β–β–ˆβ–β–„β–‘β–‘β–€β–‘β–‘β–‘β–‘β–‘β–‘β–β–‘β–ˆβ–„β–„β–‘β–‘β–‘ ░░░▀▀▄░░░░░░░░▄▐▄▄▄▀░░░ THis Question β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘β–‘ +2  

submitted by usmleuser007(370),
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rfAet osem cseaerrh tihs si hyw the rhteo swsanre rae oreitrc:nc

  1. sabal yenaektioctr ;ma&p amnlai dcilua
  2. nIorcrtce c/b inlaam ducail is a poetnmnoc of eth emtabens ebammren ihcwh si fnodu entbeew eth puhlitmeie dan guelirnnyd eecnvtiocn tissue ,g(..e sidieeprm and emsrid fo hte sni).k
  3. tI si a lguohyr 40 noarenmte ewid uotltnen-elrecc oezn bewente eht slpaam emearbnm of hte ablas lslce and teh d-nte(n)orcseeel lmania eands fo hte tmebensa ermb.nmae )K(WII
  4. alabs totyeaiknerc tschtaae to hte sebantem ebrmaenm ngisu immseheeomsod

  5. nuGraalr ttyenrakiceo m≈ tmrusat eoumrcn

  6. tStamur mdcuuil aasretpse seteh owt ys.rela
  7. reeth ear on mdessmoeo ttha tocnenc hsete wot ylrase
  8. Ieagm fro erneeecrf

  9. imaanL cdauli a;pm& iaLmna edasn -- ccilk for aeigm

  10. bhot rea atrp of eth astmeneb rbmmeean and not eht ieprdimse

  11. nelocyaMte &mpa; asbla ttneeoiykrc --- icklc rfo eigma

  12. are bhot tcecnoned ot ercoeaht aiv snadhier-Ec
  13. it is lbyabrpo hte agemda ot hsti oncoetcnin ahtt gihtm deal ot olemnama

submitted by misterdoctor69(40),

How come melanocytes:basal keratinocytes don't also have a desmosomal connection (in addition to their E-cadherin link)?

vivijujubebe  melanocyte is not part of the epidermal structure. they're at the epidermal-dermal junction and they produce melanin which is transported to the epidermal +  

submitted by usmleuser007(370),
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rneBgisilt aisedses ucsh sa imupehsgp uilsavrg V)(P nda gsuihpemp isolecafu FP)( rea iotumamune dsaeisse ni hihwc ai-oontateuidsb atgter esn.mlideogs

  • VP si sedauc yb nglacrctuii noaouitdestiab I()Gg thta tagrte 3Dgs esoigDe(mnl )3 dan memoitses 1s.Dg
  • PV is fdmteaiesn by pabrulssaa cntsaylshaio, ro srbeitls ni het scuomu maebnmre nad rstlebis in the mdi.rspeei
  • FP psteinat vhae itadaoiunbtsoe htta ategrt gD1s twhi uflrscpeiai ltresibs on het eeipmrisd tiwh no umoucs meramnbe usessi.
  • otBh saeidse sletur ni a loss of nyoakteeirct hsianoed.
  • Pseuphmgi nac losa be udsace by a aleactirb co:infeitn lbsuuol oeipimtg si an iotnncief usdcea yb a clyuscpochsaot aucimtber ahtt eresalse a tnixo hatt evseacl eth gsD1 laexllrrectau ioadm.n

submitted by osgoodschlatter10(26),
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msmeoosDes yb noctifun rtncinetonec kaetctoernysi ni eht rmtutsa susomnip - atsumrt usimpsno si teh palsaaursb er lxuEdec n ):oiapot Liduca is oot hgih ; otn ni onnutoiicnta iwht sbala lye)rca Crneumo si enev rhgh,ie uarGlnumos nad menCour rea'nt n ntotiud)i noanc aiLnam esdn (MB) nad anilam idlcau tno srctkneaotiey dan not ni aitctoonnniu erehe) ti eetlaynMoc rae ni het abals al;yer it is ont a tyenacterkio

)b si eht oyln tnopio ahtt seamk esesn eabds no isyologht dna olsa teh ylon ooipnt atth kssepa otbau -rteynroeettkaniic lkgenia

submitted by osgoodschlatter10(26),
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oeomDssmse yb tofciunn rtnoentencci ciynstteoreak in teh aumrtts psmounis - tramuts nusoimsp si the aaaspulrbs eylr .a euclExd o o:tip)an Lcidau si oto ghih ; not in cunoniiatont ihwt aalsb yacle)r Cruomne si eevn ehigrh, muunolGsar nda Comuner raent' n o)tncta diunoni iamnLa edsn BM() dan alniam dlicau otn srceaykniteto and not in ncnoiuiotant rhei e)te Mtconeealy are in teh lsaba lyaer; it si otn a iotnkyrectea

)b si eth lyon tponio hatt semak nssee daseb on ghstylooi nad aslo eth lyno pntioo atht espaks uatob iocitykettnnr-eare akenlig

submitted by ankistruggles(14),
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Why is aabls tetciayroken : rpbaauassl akorentetcyi teh lcle nctnjoui t’tsha most llkeyi to eb aeffe?tcd sI it eusceba ti’s teh lony rwesan atth litss a jnnicotu eebewnt owt no?rsieetycatk

sattanki  Not too sure on this one, but I interpreted the basal keartinocyte:suprabasal keratinocyte as the stratum spinosum region, which is known to have the most desmosomes. +