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NBME 21 Answers

nbme21/Block 2/Question#23 (35.6 difficulty score)
A 4-year-old boy with chronic granulomatous ...
Macrophages producing interleukin-1 (IL-1)🔍,📺

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submitted by usmle11a(83),
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FNI y lliw inbithi nfrnfotitideeia of 2hT eclsl nad oteehfrre (ea, )nw)bogr yatrglerou T clsl)e d fi teh case wsa ankligt obuat ruisv

teepot123  fa 19 pg 108 +  

submitted by temmy(139),
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IFN aagmm tlaesmisut ragcpeohmsa to educorp orlsgmnaau

submitted by trazobone(59),

I was so fixated on the fact that in a TB granuloma, macrophages produce IL12 or TNFalpha, not IL1. So I eliminated C and clicked B, even tho it’s not CD4 lymphocytes that produce TNFalpha. But the fact that macrophages produce IL1 still didn’t make any sense.

I couldn’t find any explanation in first aid for this (it doesn’t tell you what cells secrete IL1), but according to my notes from an immuno lecture I half paid attention to, IL1 is a cytokine of innate immunity secreted by monocytes, macrophages, endothelial cells, and epithelial cells; so basically everybody. This goes in conjunction with everything that FA says (FA18 p. 108)

makingstrides  Macrophages secrete Il-1,6,8,12 and TNF - alpha. In this scenario, the patient is Il-12 receptor deficient. When macrophages engulf an object, it releases Il-12 to stimulate T-lymphocytes, that in return, release Ifn-gamma, which would convert the macrophage into an epithiliod histiocyte. +2  
abk93  making strides is a baller Thank you +  
abk93  why is this patient il-12 deficient? +  

submitted by meryen13(22),

interferon gamma will do a few things in body--> 1 activate macrophages to kill! or to become epitheliod histiocyte to wall off infections. 2- it will increase the mac molecules on the surface of the cells. 3. it inhibits differentiation of t cell to th2 cell because th2 has anti inflammatory (il-10 secretion) and eosinophilic activation function. 4. also activated the nk cells to start killing!

bbr  and (just for completeness), promotes Th1 +  
ege  what does "Mac" stand for? "it will increase the mac molecules of the surface of the cells." Thanks! +  
saqeer  mac= membrane attack complex +2  

submitted by abk93(1),

Specifically, what is the purpose of Il-1 in this question?

is it just that macrophages make Il-1?

doesn't appear to be involved in granuloma formation.