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Retired NBME 27 Answers

nbme27/Block 1/Question#9 (reveal difficulty score)
A 34-year-old man who is seropositive for HIV ...
Proliferating spindle cells forming slit-like spaces filled with blood ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: Kaposi_sarcoma

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submitted by โˆ—shak360(19)
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(A) Dense, relatively acellular fibrous tissue with few typical fibroblasts (incorrect)

This is the characteristic description of a scar. Dermal collagen fibers increase as a result of scarring. While the majority of collagen fibers in healthy skin are collagen, type I, a scar is initially created by collagen, type III.

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Herpesviruses are enveloped, double-stranded, linear viruses

  • HSV-1 - herpes labialis (cold sores), temporal lobe encephalitis, keratoconjunctivitis
  • HSV-2 - herpes genitalis (it takes 2 to sexually transmit herpes genitalis HSV-2), neonatal herpes, viral meningitis
  • HHV-3 (VZV) - chickenpox, shingles, post-herpetic neuralgia
  • HHV-4 (EBV) - Mononucleosis, endemic Burkitt lymphoma, infects B cells through CD21, atypical lymphocytes on a peripheral blood smear (reactive cytotoxic T cells), positive monospot test happens at CD4+ < 100 mm^3
  • HHV-5 (CMV) - Mononucleosis w/ negative monospot test, AIDS retinitis: hemorrhage, cotton-wool exudates, vision loss, "owl eye" intranuclear inclusions in infected cells happens at CD4+ < 100 mm^3
  • HHV-6/7 - Roseola infantum, a high fever then a rash, (you hold roses close to your trunk): a diffuse macular rash that starts on the trunk then spreads to extremities
  • HHV-8 - Kaposi sarcoma (neoplasm of endothelium), dark violaceous plaques or nodules with vascular proliferation happens at CD4+ < 500 mm^3
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