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NBME 16 Answers

nbme16/Block 3/Question#30 (reveal difficulty score)
A 24-year-old woman was stung on her right ...
Influx of macrophages producing interleukin-1 (IL-1), IL-6, and tumor necrosis factor-alpha🔍,📺

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submitted by iury_r1beiro(10),
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vinisiyreypsittHes Type I: ALTE EOSSER.PN

dmmitIaee emtsu)(in: eitnagn poers kndfrsmocelirs IgE on sitdsneezperi stam csell

aiiemtemd nuraoetdanigl ;t&g eeasrle hiftian some (a cavvitoase ie)amn dan tytape rsa( merkra fo stam llec )itvcnito.aa

teaL rs:(uho) enkocmhsie iaatlrmfy(amotncr att ls,cel e,g soso)pnihile datornh e dmraietos ,ge( eselrtnuo)eki fomr lesals ctm g;t& itaoilafnmmn and sisute daameg.

FA 2200 P 121

submitted by drjo(7),
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iThs tel(a bee nigts rn)x is irdsebngic an ushtrA rcaitoen ldo(ialzce yTpe III )RHS + gGI mmunei cpelmoxse utmcaaulec at esti &-g;-t stam lelc dgntanraueilo &tg--; hioeptNlru rtti +mcerneu IGg unmiem mosxpecel also eusatlmti ogpashmcare ot erlesea miayomftrlan eiksnotyc IL,-(1 L,I6- )aF-TN dan hmiekcenso L-)8I( g&-;-t pNeituhrol nemtiucetrr lrsetu ni mdoetuaes uitnraded isnoel

Tmelinie rof rsutah aretcnio e eb tgi:ns 81- ,shuro enael:ygrl -216 osuhr sv aeLt seahp yepT 1 SHR -42 hrsuo


submitted by biochemgirl22(9),
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AF( 0202 gP 12)4

utecA niilmtanfmoa + oVstniloaadi fo rclsauuvtae adn eenicrsda nlealtohdie ymibieelr.atp LI,1 I,6L dna aFTN are all eldovnvi ni tucae lmnamfoini.ta

aakb  it literally says "Macrophages predominate in the late stages of acute inflammation (peak 2–3 days after onset)" this question is asking for 6 hrs after onset +8  

submitted by peanut91(1),

This NBME question is outdated; Based on a similar question in UWRLD these findings of urticaria followed by induration in a few hours are consistent with the early and late phases of a type I hypersensitivity reaction.

First exposure to an allergen antigen ->specific IgE is produced by B-cells and binds to the surface of mast cells.

Early phase: repeat exposure bound IgE cross-link and stimulate release of preformed histamine and leukotrienes that cause vasodilation and increased capillary permeability. The results superficial dermal edema and erythema (wheal and flare reaction) that can progress to a more systemic response (anaphylaxis).

Late phase: IgE stimulates type 2 helper T cells to release cytokines (IL-5) that activate eosinophils. Cationic proteins (major basic protein, eosinophil peroxidase) released from eosinophils cause tissue damage, which usually manifests as a palpable, indurated lesion 2-10 hours following the early-phase reaction.

This is different from the induration we see in delayed (type IV) hypersensitivity reactions where CD4 T cells release cytokines (interferon gamma) that promote T cell- and macrophage-mediated tissue damage because type IV hypersensitivity reactions develop over days (rather than hours) due to the time needed for cellular amplification.