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NBME 24 Answers

nbme24/Block 4/Question#35 (67.9 difficulty score)
An investigator is conducting a study of a ...
Basal keratinocyte:suprabasal keratinocyteπŸ”

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submitted by usmleuser007(373),
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fAert esmo ahreescr stih si why teh oerht ewnrssa rae rrctic:oen

asBla ertkinyecoat &;map alnima daucil

  • cnorctrIe /bc anlmia ciladu si a moncotnep fo teh tsenebam amemnebr iwhch si nfduo neewebt eth miteipehlu and inngerlduy evicnoecnt istues (,e.g. isieerdpm adn imrsde fo eht )i.nsk
  • It si a yghlrou 40 nemrantoe diwe le-ttcrulnecnoe zoen etenbwe teh pamasl eerbnmam of het aalsb lelcs dan the esno(ceel-en)drt mialan endsa fo the nsatmeeb mreab.mne IKI)W(
  • albsa onarytkiteec hecsatta ot hte nbseatme armbneme uings modsmeshmeeoi

lGuanrar onaectkeyrti am&p; rttsamu ounemcr

  • arttuSm cuilmdu tasaeerps eehts wto slr.eay
  • tereh rae no mesosoedm atth tenccno heets two yslera
  • Igaem for eefnrrcee

Linmaa cdliau p&am; Lamina saedn -- ilckc rof mgiea

  • htob rae atpr fo eht mtsebaen rmmeaben dna nto hte ipimdeser

ctenleyoMa p;am& sbala ietokrnyect --- cilkc fro aimge

  • are ohbt ennecctdo ot aecohtre aiv Ecse-danrhi
  • ti si bpaybrlo eth deagma to tsih oinneotccn thta
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(28),
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Blcyasila igskna fi uoy oknw ehPpsuimg siarugl.V nSptiaorea fo ualbrprsisaa pierdi,mes tnacti alasb aronkeisttyec sv osBlolu m-tgpip-ih;odeg& dlneusic opaienrsat fo abasl lreay

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(395),
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"somseeomD ulacM(a ndhese)ra - A olcl-ce-tell oncenotcni ttha drveposi tatruclrus ptopsru iwht amdettrieeni ,mealtifns rrulpaitlayc in setuiss that erdugon mcilnecaah tssesr e(g.., ns,ki sitragc stse,iu aerb)ld.d ncCentso csiryekotnate ni eth tratsum psomusni of hte .eripe"sidm - ASSBMO

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(14),

submitted by brethren_md(87),
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tiduSp n,sequoit teoyhnls just akte oury tbse geuss and move no llo.

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(373),
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tAefr meos srhceear tihs is ywh eth treho enrwssa aer crri:encto

  1. baals iteatcoeynkr am;&p malnai ldiuca
  2. crcIrtoen b/c ialanm ilaudc si a ontcpoenm fo teh enetmsab abmrneme whhci is udofn weneetb the themeuplii nad unrldngiye cnnevocite siesut g.(.,e ieesmirdp adn dremsi fo teh s.i)nk
  3. tI si a ryuglho 40 menarteno iwed en-rctcletnuole znoe enetebw het spaalm mebaernm of eht sabla lcsel adn eht e-rtoee(ecnslnd) manila sndae fo the seebnmta nr.mamebe WK)(II
  4. balas nyoeitkatrec stahaetc to eth aenmsebt nmrameeb nsgui sdiemoemmohse

  5. uanarGlr tnetkacoiery &;apm masttur emoncur

  6. tuamtrS lmicudu tasseeapr steeh owt .ersaly
  7. rehet rea no sodemseom that cnotcen etesh two seyalr
  8. egIma rfo ereenfrec

  9. mnLiaa claudi pma;& miLaan ansde -- clkic ofr iamge

  10. bhot ear arpt fo the msaetenb erbmname and tno the mreedispi

  11. leecnaMyto ;&pma alsab oeretkicnyt --- iclck orf iamge

  12. rae both otednccne ot htoeearc iva dEcieans-rh
  13. ti is aolpbryb hte dmgaea ot htis nioenncoct atth mtigh elda to anamlome

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(373),
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stlBnigrei seaediss hsuc as eighspump sgivurla V)(P nad sgiheppmu iuolceafs )F(P rae uomnmituae deesaiss ni hchiw tsoediaunto-abi taertg den.esosmilg

  • PV is ucaeds by gtccruliani ouibsdtanteoai IgG)( taht aergtt D3sg mel(sgeonDi 3) nda tiemssmeo 1s.Dg
  • VP si sdtineamef by sparaaulbs ola,canihstys or rslibtes ni eth csmuuo anmeerbm dna lrstiesb in eht e.dreipmis
  • PF ttnpesia hvea sotnoiebdituaa ahtt ttaegr 1sgD htiw uaclsrefiip sbrltsei on eth reisdemip tihw no ocumus meabnemr ue.siss
  • hBot dieaess tresul in a sosl of teiycakotern saenihdo.
  • ipusPmegh nac olsa be csdeau by a reicaabtl ot:enicinf oslluub eigtompi si na conntiife duecsa by a tlasccyuchoosp uberticma atth reesseal a noxit ttha asveelc teh sD1g ulalexltrrcea .andoim

submitted by osgoodschlatter10(27),
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semooDemss yb uctionfn tncnecnroite skeentocytair ni the tstrmau inmsupso - rtumast sonuspim si eht rlspabaaus .erlya cxElude )t :pnaoio ciuLad is too ighh ; tno in tcoanounntii iwth aaslb lay) rce muCeonr si veen erhgih, lGmanuorsu nda nroeumC e'nart n d unanito)oticn Lmania nsed (BM) adn mainal liadcu nto tetncyoerksai adn tno ni ntaonitoniuc erethi) e yceonlMate rea ni the basal ryeal; it si ton a iytekcteanro

)b si eht onyl optnoi tath emask snsee bades no gshitoyol adn lsao eht nylo tnopoi ttha akspse otabu yeotnaiircr-tnteek niglake

submitted by osgoodschlatter10(27),
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Dmosoesesm by ntifcnou tnecrentocin enasyetctokri ni teh tmutasr pusisnmo - trusamt iumnpsos si eht urassbalpa rlye. a ledExuc not)ai: op icauLd si oot high ; ont in ncuinoioattn wtih laabs )ea lcry moCrune si neev hghr,ei srlGounamu dan ruonCme re'tan n ntaoo)uinnt cdi aLinma sned B(M) and miaanl ucilad nto eotrcatniyesk nad nto in uanitncotnio ieetr)he tneaMeocly aer in het lbasa ;rayel ti si ton a otitnecareyk

)b is teh nloy oopnti that akesm esnes asdbe on soghlyoit adn aols eth onyl oinotp ttha ksspea btaou ciytnetkoenatie-rr ieklnga

submitted by ankistruggles(14),
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hyW si labsa nytceoikrtea : auplsrsbaa yroteteinkac eht ellc ncnjuiot as’htt somt yellik ot be t?caefedf sI ti ceasube t’si teh lnyo rwasne taht istls a jnnuciot enebetw owt sko?ietetncrya

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. +