possible nbme 12 spoiler: ppd reaction??

[WashMe]

If you did a biopsy of indurated skin following a ppd test, you'd expect to see predominantly T-cells, wouldn't you? Since it's a type 4 (DTH) reaction? I don't think you'd see a bunch of macrophages, would you?

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[SeekerOfTheTree]

If you did a biopsy of indurated skin following a ppd test, you'd expect to see predominantly T-cells, wouldn't you? Since it's a type 4 (DTH) reaction? I don't think you'd see a bunch of macrophages, would you?

What forms the granuloma during the reaction directly? I believe it would be the macrophages. How was the question worded? The T cells should be there to activate and process the antigen but when you have the granuloma you are looking at macrophages going buckwild and having an orgy.

 

[WashMe]

What forms the granuloma during the reaction directly? I believe it would be the macrophages. How was the question worded? The T cells should be there to activate and process the antigen but when you have the granuloma you are looking at macrophages going buckwild and having an orgy.

Hmm... maybe you're right. Basically the question said what I posted; a health care worker got a ppd test and it had 25mm of induration. When you biopsy the area, what is the predominant cell type? It's a beastly question be honest, since we've been drilled so hard that the reaction is T-CELLS T-CELLS T-CELLS lol

 

[SeekerOfTheTree]

Hmm... maybe you're right. Basically the question said what I posted; a health care worker got a ppd test and it had 25mm of induration. When you biopsy the area, what is the predominant cell type? It's a beastly question be honest, since we've been drilled so hard that the reaction is T-CELLS T-CELLS T-CELLS lol

Yeah I agree with you. This one is tricky especially because of the T-Cell mantra we are taught.

 

[WashMe]

while we're on the topic of NBME's, how do you differentiate between acute pyelonephritis and acute tubulointerstitial nephritis when they basically give you a terrible picture and you can only see a bunch of WBC's in the tubules? The clinical scenario was a woman in late pregnancy with 1 day of flank pain, fever, and CVA tenderness. Was I supposed to know from the surrounding information?

 

[san5a]

I agree with the initial response by Seeker, T cells are there initially to process the tuberculin Ag, then the macs are activated and secrete a whole bunch of IL-1, IL-6, IL-8, TNF-alpha to mediate DTH. Macs are known for walling off crazy stuff they can't handle, making granulomas and dumping junk for necrosis.

 

[SeekerOfTheTree]

while we're on the topic of NBME's, how do you differentiate between acute pyelonephritis and acute tubulointerstitial nephritis when they basically give you a terrible picture and you can only see a bunch of WBC's in the tubules? The clinical scenario was a woman in late pregnancy with 1 day of flank pain, fever, and CVA tenderness. Was I supposed to know from the surrounding information?

I know the question you are talking about. I look at the glomeruli and see if there are more than the normal number of cells in there. If there are and we are looking at an infection possible then it's pyelo. I think anothing thing was she had a fever so that made me think more infectious than with ATN where you really have ischemia or toxin as the issue so fever is less likely.

Since we are on this topic do you remember that question about the kidney with the swollen eyed kid? They gave you a picture of the glomeruli. What the heck was that? Was it Minimal Change Disease? I can't for the life of me tell the difference between a membranous and a normal glomerulus.

 

[SeekerOfTheTree]

I agree with the initial response by Seeker, T cells are there initially to process the tuberculin Ag, then the macs are activated and secrete a whole bunch of IL-1, IL-6, IL-8, TNF-alpha to mediate DTH. Macs are known for walling off crazy stuff they can't handle, making granulomas and dumping junk for necrosis.

You know some people say the urban term "Mac Daddy" came to be because of an immune researcher who became a rapper. He was inspired by the power of the macs and how they were crazy and nobody wanted to mess with them so he decided to go by mac daddy.

 

[WashMe]

I know the question you are talking about. I look at the glomeruli and see if there are more than the normal number of cells in there. If there are and we are looking at an infection possible then it's pyelo. I think anothing thing was she had a fever so that made me think more infectious than with ATN where you really have ischemia or toxin as the issue so fever is less likely.

Since we are on this topic do you remember that question about the kidney with the swollen eyed kid? They gave you a picture of the glomeruli. What the heck was that? Was it Minimal Change Disease? I can't for the life of me tell the difference between a membranous and a normal glomerulus.

I suck at all the kidney stuff and I don't remember that one (no surprise, I forget all kinds of stuff lol)

You know some people say the urban term "Mac Daddy" came to be because of an immune researcher who became a rapper. He was inspired by the power of the macs and how they were crazy and nobody wanted to mess with them so he decided to go by mac daddy.

hahaha!

 

[SlaveOfTCMC]

I know the question you are talking about. I look at the glomeruli and see if there are more than the normal number of cells in there. If there are and we are looking at an infection possible then it's pyelo. I think anothing thing was she had a fever so that made me think more infectious than with ATN where you really have ischemia or toxin as the issue so fever is less likely.

Since we are on this topic do you remember that question about the kidney with the swollen eyed kid? They gave you a picture of the glomeruli. What the heck was that? Was it Minimal Change Disease? I can't for the life of me tell the difference between a membranous and a normal glomerulus.

It was minimal change indeed.

Normal glomerulus looks just like that. Thin capillary loops all around with slightly darker red mesangium.

A membranous glomerulonephritis will just look very thickened around the capillaries.

Look up some pictures for reference

 

[SeekerOfTheTree]

It was minimal change indeed.

Normal glomerulus looks just like that. Thin capillary loops all around with slightly darker red mesangium.

A membranous glomerulonephritis will just look very thickened around the capillaries.

Look up some pictures for reference

Damn, I suck at life! Thanks for clarifying that. I need to be in love with a normal glomerulus.