USMLE PRACTICE QUESTION #96
TOPIC: Foundational Histology
Today’s question will test your understanding of a high-yield histology detail.
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A 25-year-old female presents to her primary care physician complaining of persistent dry cough and fatigue for six months. She also reports anorexia and a fifteen-pound weight loss. Chest radiography demonstrates bilateral hilar lymphadenopathy without reticular opacities. Laboratory investigations reveal elevated levels of ACE and a serum calcium level of 12.3 mg/dL. Which of the following is most likely to be isolated from this patient’s biopsy?
A) Lewy bodies
B) Schaumann bodies
C) Russell bodies
D) Mallory bodies
E) Councilman bodies
Detailed Breakdown of Answers + Correct Answer Below ⏬
ANSWER + QUESTION BREAKDOWN
The MENTAL MODEL used to answer this question comes from our detailed test-taking skills masterclass (check it out if you want to elevate your skills). Here’s how to think through this question:
Step 1. Read the last line to get to the heart of the question: “Which of the following is most likely to be isolated from this patient’s biopsy?”
Step 2: Is this a first-, second-, or third-order question?
Answer: 2nd order. 1st: Identify the diagnosis; 2nd: Recognize the correlated histological finding.
Step 3: Read the vignette carefully and ask yourself: “Based on my diagnosis, which histology finding am I likely to find?”
Step 4. Look at the answer choices and select the option most closely resembling your final thought from “Step 3” above.
GENERAL ANALYSIS
A 25-year-old female with a 6-month history of persistent dry cough, fatigue, anorexia, and significant weight loss, chest radiography showing bilateral hilar lymphadenopathy, and elevated ACE and calcium levels are highly suggestive of sarcoidosis.
ANSWER CHOICES:
CHOICE A: Lewy bodies
Explanation: Lewy bodies are abnormal protein aggregates, primarily alpha-synuclein, found in neurons. They are associated with neurodegenerative diseases such as Parkinson's disease and Lewy body dementia.
CHOICE B: Schaumann bodies
Explanation: Schaumann bodies are laminated, calcified structures found within giant cells of granulomas. They are commonly seen in sarcoidosis and other granulomatous diseases like berylliosis and hypersensitivity pneumonitis. Schaumann bodies are composed of calcium and protein deposits.
CHOICE C: Russell bodies
Explanation: Russell bodies are eosinophilic inclusions that contain immunoglobulins. They are typically found in plasma cells undergoing excessive synthesis of immunoglobulin and are associated with conditions like chronic inflammation or plasma cell dyscrasias (e.g., multiple myeloma).
CHOICE D: Mallory bodies
Explanation: Mallory bodies (also known as Mallory-Denk bodies) are cytoplasmic inclusions composed of intermediate filaments and other proteins. They are typically found in hepatocytes and are associated with liver diseases such as alcoholic liver disease, non-alcoholic steatohepatitis (NASH), and Wilson’s disease.
CHOICE E: Councilman bodies
Explanation: Councilman bodies (also known as apoptotic bodies) represent hepatocyte apoptosis and are typically seen in cases of viral hepatitis or yellow fever.
FINAL VERDICT…
The clinical presentation of this patient is highly suggestive of sarcoidosis, a systemic granulomatous disorder characterized by non-caseating granulomas. Key findings supporting this diagnosis include:
Persistent dry cough, fatigue, weight loss
Bilateral hilar lymphadenopathy on chest X-ray
Elevated angiotensin-converting enzyme (ACE) levels
Hypercalcemia
Sarcoidosis is known to cause the formation of non-caseating granulomas, which may contain characteristic inclusions such as Schaumann bodies—laminated calcified structures made up of calcium and protein deposits inside Langhans giant cells.
These inclusions are not pathognomonic for sarcoidosis but can help support the diagnosis when seen on biopsy. Thus, Schaumann bodies are the most likely inclusions to be isolated from this patient’s biopsy based on her clinical features consistent with sarcoidosis.
CORRECT ANSWER: B) Schaumann bodies
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That’s it for question 96!
See ya tomorrow 👋