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* NBME 15 Question, Please help, exam in 3 days!
 #743868  
  gillycricket - 08/10/13 14:27
 
  A 56-year-old woman comes to the physician because of a 3-week history of progressive difficulty swallowing. When her symptoms began, she felt that bread and larger pieces of meat were getting stuck in her chest before passing through completely, but now she is having difficulty swallowing all foods and some liquids. Physical examination shows normal oral coordination and a nontender abdomen. An x-ray obtained after a barium swallow shows an irregular mass at the gastroesophageal junction. A photomicrograph of a biopsy specimen obtained via esophagogastroduodenoscopy is shown. Chronic infection with which of the following pathogens is the most likely cause of the histologic findings in this patient?


a)Clonorchis sinensis
b)Cytomegalovirus
c)Entamoeba histolytica
d)Helicobacter pylori
e)Mycobacterium tuberculosis

Image link: http://s8.postimg.org/h5foh4mr9/Untitled_True_Color_01.jpg

I cant say what the image is. I narrowed down the search to D and E. If the picture is a granuloma, then it is tb. If the picture is adenocarcinoma, then it might be H pylori. But what I know is H pylori doesnt have any role in esophageal adenocarcinoma. The mechanism of esophageal adenocarcinoma is GERD --> metaplasia --> adenocarcinoma.

Requesting help from any kind heart!
 
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* Re:NBME 15 Question, Please help, exam in 3 days!
#2926239
  gillycricket - 08/10/13 15:00
 
  anyone?  
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* Re:NBME 15 Question, Please help, exam in 3 days!
#2926266
  localite - 08/10/13 15:48
 
  a) clonorchis sinensis also known as liver fluke
mode of human ingestion is thru fish cyst usually lodges itself in the liver and causes inflammation and obstruction of the the bile ducts..progressing to cholangiocarcinoma which is also an adenocarcinoma. Initially the disease is asymptomatic when the symptomps appear the disease has metasitized to adjacent organs . this histopath image shows adenocarcinoma.
 
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* Re:NBME 15 Question, Please help, exam in 3 days!
#2926269
  gillycricket - 08/10/13 16:06
 
  Localite, thanks for your explanation.

If the picture is adenocarcinoma, then I will go with (D)--> H. pylori.
 
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* Re:NBME 15 Question, Please help, exam in 3 days!
#2926270
  gillycricket - 08/10/13 16:08
 
  Anybody got it right or wrong in NBME?  
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