• Practice your interview with the new SDN AI Interview Coach. Choose a school, answer by voice or typing, and receive a personalized feedback report. Available now to all SDN members. Try the AI Interview Coach.

Step I USMLE images

Started by Zuhal
Your USMLE Scores Increased, Guaranteed!
This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Zuhal

Zuhal

Full Member
10+ Year Member
Advertisement - Members don't see this ad
68 yo male patient presents to your clinic with postprandial pain. X-ray below, whats the dx?
 

Attachments

  • x.jpg
    x.jpg
    29.8 KB · Views: 1,217
Sort by date Sort by votes
Jonari said:
yeah...no, i came to the same conclusion and the derm said the same thing too...hopefully it'll go away when the test is done...thanks for the insight...back on topic now 😳
Click to expand...

Sure it's the water and not your soap? Also try a water softner, you could be allergic to one of those heavy metals and others aren't.
 
Upvote 0 Downvote
Advertisement - Members don't see this ad
SLC said:
Mee's lines, arsenic poisoning?

There's a Beau's line near the tip of the lunula too.
Click to expand...

Its Beau's line, not mees though... they look different.

Systemic disease implicated if all 20 nails involved. Pathogenesis: Occur after any severe, sudden, acute, particularly febrile illness; damage to matrix. Etiology: High fever, postnatal, cytotoxic drugs, severe adverse cutaneous drug reaction. Findings: Transverse, bandlike depressions in nail, extending from one lateral edge to the other, affecting all nails at corresponding levels (Fig. 33-23). If duration of disease completely inhibits matrix activity for 7–14 days, transverse depression results in total division of nail plate (onychomadesis). Multiple parallel lines with chemotherapy. Duration: Thumbnails (lines present for 6–9 months) and large nails (lines present for up to 2 years) are most reliable markers.
Click to expand...

from clinical derm atlas
 
Upvote 0 Downvote
addo said:
Its Beau's line, not mees though... they look different.



from clinical derm atlas
Click to expand...

Yeah, I've only seen them look like a clear depression (like the one nearest the cuticle) never seen one that was pale colored like the one in the mid-nail. It's tough to see if there's a depression there or not.

Mee's lines are pale bands through the nail, a lot like that image, but everyone I've seen had faint borders.

But the pale one could (and probably does) represent a more severe attack of whatever this person has that's causing the lines, it looks like the nail almost split.
 
Upvote 0 Downvote
Jonari said:
1. paraesophageal hernia
2. SaO2 = saturation of rbcs with hemoglobin, right? other lung is still working fine and being able to oxygenate the rbcs...so shouldn't it be normal?
Click to expand...

SLC said:
1) Defective development of the pleuroperitoneal membrane (which becomes the diaphragm)
2) I gotta think the SaO2 is decreased.
Click to expand...

No. Does anyone wanna give it a try before I tell you the answer?
 
Upvote 0 Downvote
Advertisement - Members don't see this ad
Jonari said:
is this something about how the organs herniate in the posterlateral style into the retroperitoneum by any chance? i remember reading something similar to this in goljan's rr
Click to expand...

Yea thats called a Bochdalek hernia, I dont know if thats what Zuhal is looking for?
 
Upvote 0 Downvote
Okay maybe I confused you there by giving you that hint about diaphragmatic hernia

I'll just go ahead with the concept:
Diaphragmatic Hernia---> Hypoplastic Lung---> Decrease O2---> PDA (which is what the image shows).
 
Upvote 0 Downvote
34 year old presents to E.R. with fever, jaundice, and anorexia. Has upper right quad pain.

here is the liver biopsy: What is this type of cell, what does it contain, and what is the disease?

05961.jpg


edit: sorry picture is so big. black thing is an arrow pointing to the pathology.
 
Upvote 0 Downvote
tiedyeddog said:
34 year old presents to E.R. with fever, jaundice, and anorexia. Has upper right quad pain.

here is the liver biopsy: What is this type of cell, what does it contain, and what is the disease?

05961.jpg


edit: sorry picture is so big. black thing is an arrow pointing to the pathology.
Click to expand...

Kupffer cells, in alcoholic hepatitis?
 
Upvote 0 Downvote
SLC said:
Hyperparathyroidism?

I forgot Paget's presents with normocalcemia since it's a remodeling problem, not a pure osteolysis problem.
Click to expand...

that's it, great work.

This is salt and pepper calavarium, which is periosteal thinning.

I am actually not sure how to differentiate this form multiple myeloma.... both would presents with hypercalcemia and bone structural changes...hm. I guess it requires looking for an M spike.
 
Upvote 0 Downvote
tiedyeddog said:
that's it, great work.

This is salt and pepper calavarium, which is periosteal thinning.

I am actually not sure how to differentiate this form multiple myeloma.... both would presents with hypercalcemia and bone structural changes...hm. I guess it requires looking for an M spike.
Click to expand...

i know most don't do kaplan Q bank but when i did it...there was a question that had both answer choices up there...it also included that the ESR was elevated, talked about doing a biopsy showed congo red stain, and in the urine you saw features "which were indicative of features found on an antibody structure".

so i guess seeing those extra clues are needed to differentiate between the two
 
Upvote 0 Downvote
tiedyeddog said:
34 year old presents to E.R. with fever, jaundice, and anorexia. Has upper right quad pain.

here is the liver biopsy: What is this type of cell, what does it contain, and what is the disease?

05961.jpg


edit: sorry picture is so big. black thing is an arrow pointing to the pathology.
Click to expand...

Ito cell aka ? (brain fart atm would get it out of a multiple choice answer though) Contains Vitamin A.
 
Upvote 0 Downvote
MLT2MT2DO said:
Ito cell aka ? (brain fart atm would get it out of a multiple choice answer though) Contains Vitamin A.
Click to expand...

I'll give it up, I think it's a rather obscure pathology but I got a UW question on it.

It's a councilman body, it has acidophilic granules and indicates apoptosis. They are seen are a viral hepatic infection (most likely hep B or C in this case due to drug use). I think they go along with spaces int he liver and hepatocyte balloning.

http://en.wikipedia.org/wiki/Councilman_body

another pic:
Hepatitis%20A%20(Councilman%20body)(HE)%20x%20300.jpg
 
Upvote 0 Downvote
Advertisement - Members don't see this ad
tiedyeddog said:
I'll give it up, I think it's a rather obscure pathology but I got a UW question on it.

It's a councilman body, it has acidophilic granules and indicates apoptosis. They are seen are a viral hepatic infection (most likely hep B or C in this case due to drug use). I think they go along with spaces int he liver and hepatocyte balloning.

http://en.wikipedia.org/wiki/Councilman_body

another pic:
Hepatitis%20A%20(Councilman%20body)(HE)%20x%20300.jpg
Click to expand...

I would think these are actually pretty high yield - they show most of the typical features of apoptosis
 
Upvote 0 Downvote
CrouchingLiger said:
are those neurofibrillary tangles? Intracellular hyperphosphorylated Tau protein, with alzheimer's, chromosome 21. Don't recall how to slow it down though...
Click to expand...

👍, right dx of alzheimer's...but that's Abeta amyloid...didnt know what it was because i've always seen questions with this type of picture

http://upload.wikimedia.org/wikiped...on_with_Alzheimer-related_pathology,_HE_3.JPG

yup, chromosome 21 causes the Abeta deposition...and other chromosomes for alzheimer's include: 1 and 14 for early onset, and 19 for late onset.

you can help alzheimer's pts by giving achesterase inhibitor (ie donepezil, tacarine) and can also give galantamine (sp?)...doesnt do anything with respect to amyloid formation, just helps to increase overall ach levels at the basal nuc
 
Upvote 0 Downvote
startswithb said:
I can't figure out how to post images, too lazy to save as.
Click to expand...

lol. You can directly link to ones you get online without saving them if you want

Okay I'll contribute to this since I don't want it to die out. Dx?

Also while we're on this topic, anyone have any suggestions on how to keep all these renal pathologies straight? They all look so similar to me now matter how many times I see them. I always get the associations and even names mixed together (diffuse membranous segmental progressive glomerulonephritisopathy apparently isn't a thing haha).
 

Attachments

  • 640px-Diffuse_proliferative_lupus_nephritis_-_high_mag.jpg
    640px-Diffuse_proliferative_lupus_nephritis_-_high_mag.jpg
    74.1 KB · Views: 181
Upvote 0 Downvote
Advertisement - Members don't see this ad
sharklasers said:
yep, looks like a high mag image of diffuse proliferative lupus nephritis to me 😛
Click to expand...
Hah, didn't realize the file name had the description. Yeah its diffuse proliferative lupus neprhitis, aka diffuse proliferative glomerulonephritis.

Here's a picture of diabetic glomuerulonephropathy aka nodular glomerulosclerosis, it still looks the same to me, so I'm not sure how to tell them apart?
Nodular_glomerulosclerosis.jpeg

Any renal path experts here want to try to explain this a little better?

and for Jamiu: Yeah supposedly it would be more cellular with membranoproliferative if thats what you were referring to, so yeah, not enough black dots on that last one.
 
Upvote 0 Downvote
You must log in or register to reply here.

Similar threads

satdixon
USMLE/COMLEX Step 2 Strategy
Replies
1
Views
1K
eteshoe
eteshoe
D
  • Question Question
USMLE/COMLEX COMLEX Level 2 Tutor
Replies
0
Views
2K
DOStudent5
D
A
Step III USMLE STEP 3 and licensing
Replies
0
Views
2K
anonymous22022
A
D
USMLE/COMLEX A study buddy app for USMLE Step 1 and Step 2 exam prep
Replies
0
Views
729
dhumru
D
S
USMLE/COMLEX 5 Months Until Step 1 - Need Study Advice
Replies
1
Views
656
drmednotes-
drmednotes-