Perhaps
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Please help me with these two questions (pictures are in attached file; use word to open). Thanks!
19. This one has a picture of kidney, see attached file.
A 68-year-old woman is admitted to the hospital for evaluation of gross hematuria. Two days after admission she develops aphasia and right hemiplegia, followed shortly by coma and death. The cut surface of one of her kidneys as seen at autopsy is shown. Which of the following was the most likely cause of the hematuria?
A) Metastatic cancer
B) Papillary necrosis
C) Polycystic kidney disease
D) Renal abscess
E) Renal cell carcinoma
F) Renal infarct
1. This one has a pictureo f the hand. Please see attached file.
A 9-year-old boy has had the lesions shown for several months. Which of the following histologic changes would be most likely if this lesion were biopsied?
A) Cytoid bodies and loss of adhesion to adjacent cells
B) Epidermal acanthosis with subepidermal blister
C) Epidermal thinning with marked inflammatory dermal infiltrate
D) Marked squamous cell dysplasia with thinned stratum corneum
E) Thickened stratum corneum and epidermis and vacuolated squamous cells
Attached Files:
nbme q.doc (670 KB, 68 downloads)
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| tash
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First question, I'd go with C, Polycystic Kidney disease. Considering the age of the patient and the symptoms, it seems she had an APKD, associated with berry aneurysm, which eventually may have produced a hemorrhage.
Second question, I guess the answer is E. Just a feeling, no good reasoning, please correct me if I am wrong. It doesn't seem to be a malignant lesion, just seems the stratium corneum is markedly thickened.
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| Perhaps
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Hi Thanks for the input!
The first q:
I agree the symptoms are consistent with APKD, but I can't see the cysts.
I was wondering if it could be a metastatic cancer from another organ, which metastasize to kidney and brain.
Or, could it be a kidney cancer metastasizing to brain. The whitish area does not look like a tumor though.
Or, could it be some kind of multiple infarct that lodge into kindney and the brain, but the supposed infarcted area is not wedge shaped.
The second Q:
Can it be pemphgus vulnarus or psoriasis?
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| ssrpk
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#1- pt had atrial fibrillation which results in multipe embolic apisodes, causing renal cortical infarcts and stroke, in the given figure, it's not perfectly wedge shaped, but it follwos the same basic pattern - answer is E
#2- verrucua vulgaris - very common in young children due to HPV infection, resolves itself in about 6 months to 2 years! answer is E [check out the given figure in robbin's]
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| ssrpk
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sorry i mistyped, it's not E, it's F- infarct
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| Perhaps
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Hi, Thanks for the help!!! Very nice answers and explanations!
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