DwyaneWade

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There seems to be a mismatch between UWorld and Goljan on this subject. All of the lesions associated with IBE (Roth spots, Janeway lesions, Osler nodes, glomerular disease), are they due to immune complex/Type 3 HS or are they embolic phenomenon?

I had a UWorld question where the answer was microemboli but Goljan clearly says the opposite in his lectures.

-DWade
 

Proverbs31

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We must've had the same question last night? The main with IBE and it shows a picture of his feet with microemb?

If so in that question there was no other answer that could have been right.

Splinter hemorrhages, janeway lesions, oslers....are All type 3 Hypersensitivities...they are vasculitises. They deposit causing microembol/hemorrhage. Thus where you get the hemorrhages...otherwise you wouldnt have a cause for why they are red spots on you...
Maybe you had a diff quest?
 

medhacker

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The exact pathogenesis of Janeway lesions and Osler Nodes is unknown - that is whether they are embolic or type III HS in nature.[1] UW only mentions Janeway lesions and Osler nodes as being embolic. Goljan says that the cardiac vegetations embolize and infarct distant sites.[2] Goljan doesn't even mention Janeway lesions on his Path RR book. Furthermore, he states that splinter hemorrhages in nail beds, and glomerulonephritis as a sequelae to IBE is in fact an immunocomplex vasculitis - UW does not contradict that.[2]

1. Chapter 29, CURRENT Diagnosis & Treatment in Cardiology
2nd Edition, Michael H. Crawford M.D.
2. Goljan RR pathology pg. 190
 

nycli

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Just got the same question in UW and wanted to bump this thread. Does anyone know if there's a consensus on whether the USMLE identifies Janeway lesions and Osler nodes as Type III or as septic emboli? Or is this too controversial for them to test...?