To Sarim..NBME1-2-42,44 - maryam2009

[ArchivalUser]

Hi Sarim
Q42

I think the F is much more closer to the correct option..because the patient doesn't have fever,chills or cough (the lobar consolidation),and choice E becomes dismiss from consideration

Q44.B

BRANCHIAL CLEFT CYSTS are congenital cysts, that arise in the lateral aspect of the neck when the second branchial cleft fails to close during embryonic development.

They are bilateral in about 2-3% of the cases. Usually, ***they do not appear at birth, but become noticeable much later in life***. If they get infected, they may form a deep neck abscess or a draining fistula.

While a cystic hygroma is a congenital multiloculated lymphatic lesion that can arise anywhere, but is classically found in the left posterior triangle of the neck. This is the most common form of lymphangioma. It contains large cyst like cavities containing watery fluid. Microscopically cystic hygroma consists of multiple locules filled with lymph. In the depth the locules are quite big but they decrease in size towards the surface.

for more information

http://www.ghorayeb.com/branchialcleft.html
-----------------------------------------------------------------------
please clarify my answers,

Thank you

[ArchivalUser]

Maryam, if you don't mind I will drop my two cents here. I agree with you of Q.42. It's the pleural infusion, based on the dulness to percussion and decreased tactile and vocal fremitus(which wil be increased in pneumonia or interstitial infiltrate, plus patient doesn't have fever).
And Q.44 I agree that it's a brachial cyst.
Thank you for your discussions.
L.

[ArchivalUser]

Hi,lovetest

You are always welcome

Regarding Q.44 I think Cystic Hygroma is correct.

[ArchivalUser]

the reason I am trying to go against cystic hydroma is that it multicolucal and contains lymph, which won't be cleat, but milky. Plus, cystic hydroma is common in patients with Turner syndrome and will be with other congenital abnormalities, but this neonate is healthy.

[ArchivalUser]

wanted to add more, Turner syndrome is characteristic for female gender, but here we have a male neonate. Really want to hear other discussions as well.

[ArchivalUser]

Hello

42-yes it is "Pleural Effusion" and this is what i have .....typo on the key

44- I also thought "B"(cystic Hygroma) based on it's location "Posterior to sternocleidomastoid"

-there has been so many heated discussions on this Q and i also wasted so much of my time.

-At the level of USMLE step 1......how does the examiner expect us to know the cyst fluid consistency when it comes to this topic....when i read more sources looking for the answer sometimes i thought it is B.cyst and sometimes C.hygroma....in the end i just wasted my time on it.

my advice:pick A or B and leave this Q alone

[ArchivalUser]

Sure,it is my last touch up .and I promiss I will never get back to them )

Many thanks to you for spending your time on these types of QS.