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  #1  
Old 10-22-2012
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Arrow Billy Step 1 Questions # 43

A 43-year-old woman with a long history of chronic allergies visits her primary care physician with a 2-week history of progressive left perinasal pain and nasal pressure, increasing episodes of yellowish-green nasal discharge,and a fever 1 day prior of 100.8F. Significant findings on physical examination include a temperature of 101.0F, tenderness to palpation over the left maxillary sinus, and nasal speculum observation of obstruction of the left middle meatus by a large, pale, polypoid mass with a small focus of ulceration and a similar but smaller mass seen in the right middle meatus. A clinical diagnosis of left maxillary sinusitis is made and the patient is started on antibiotics. She is subsequently referred to an otolaryngologist who excises the bilateral masses to relieve the sinus obstruction. Which of the following findings would you expect the pathologist to see on microscopic examination of these masses?


(A) hyperkeratotic squamous epithelium with a submucosal core of myxoid connective tissue, frequent blood vessels, mild fibrosis, and a mononuclear infiltrate
(B) myofibroblastic proliferation in a dense fibrovascular stroma with numerous endothelial-lined channels
(C) papillomatous proliferation of squamous epithelium extending downward through the submucosal connective tissue
(D) respiratory epithelium containing an edematous, loose stroma and a mixed inflammatory infiltrate, with a prominence of neutrophils and eosinophils
(E) undifferentiated large epithelial cells with round vesicular nuclei and prominent nucleoli in a syncytial arrangement with a marked lymphocytic infiltration
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Old 10-22-2012
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(D) respiratory epithelium containing an edematous, loose stroma and a mixed inflammatory infiltrate, with a prominence of neutrophils and eosinophils
Cystic fibrosis----sinonasal polyps
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Old 10-22-2012
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D) seems the right answer
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Old 10-22-2012
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I would choose D) also, because is the only answer that has eosinophils in the microscopic presentation (chronic allergies, nasal polyps).
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Old 10-22-2012
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my ans is D:confused
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Old 10-22-2012
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Default Edematous form

D.
Given her history of allergies I would assume these are nasal polyps which are most commonly edematous and most common inflammatory cells seen are eosinophils. Not sure if the fact that the polyp has an ulcer looks to something else though as usually allergic polyps do not ulcerate (at least from what I can recall correct me if I am wrong!)
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Old 10-23-2012
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Correct Answer D is correct

Given the history of allergies and the finding of bilateral polypoid masses, it is most likely that this patient has nasal polyps, the typical histology of which is as described. Hyperkeratotic squamous epithelium with a submucosal core of myxoid connective tissue, frequent blood vessels, mild fibrosis, and a mononuclear infiltrate (choice A) is the histological description of a vocal cord polyp. Myofibroblastic proliferation in a dense fibrovascular stroma with numerous endothelial-lined channels (choice B) describes the histology of a nasopharyngeal angiofibroma. Papillomatous proliferation of squamous epithelium extending downward through the submucosal connective tissue (choice C) refers to an inverted papilloma. An undifferentiated large epithelial cells with round vesicular nuclei and prominent nucleoli in a syncytial arrangement with a marked lymphocytic infiltration (choice E) is the histological description of an undifferentiated nasopharyngeal carcinoma.
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Old 10-23-2012
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Where did you get this question?
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Old 10-24-2012
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Default D

Nice question
I am suspecting Allergic polyps
so D
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  #10  
Old 10-24-2012
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Its from Lange Q/A for USMLE Step 1
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Old 10-24-2012
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Quote:
Originally Posted by koolkiller88 View Post
Nice question
I am suspecting Allergic polyps
so D
Is there mention of it in first aid ?
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