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Retired NBME 23 Answers

nbme23/Block 3/Question#30 (reveal difficulty score)
A 20-year-old woman comes to the physician ...
C1q ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—notadoctor(175)
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SLE is associated with deficiency of early complement proteins(eg. C1q, C4, C2). (FA 19, pg. 462)

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tinydoc  Am I the only one who has never heard of C1Q? +34
llamastep1  I knew SLE is related to low complement but when it talked about a "mutation" it threw me off. +2
xmen  Yessssssssss FA 2019 P462. Assoc iated with de fi ciency of ea rly complement protei ns (eg, Clq, C4, CZ) - I clearance of immune complexes. +



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submitted by โˆ—thomasalterman(181)
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Complement is important for removing immune complexes, so patients with complement deficiencies *(c1-c4) are more likely to develop SLE. C1q is a better answer than than MBL (D) b/c the MBL pathway is triggered by bacteria.

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myoclonictonicbionic  Thats the reason I put MBL, because the question mentioned that it got worse when she went to the beach so I was thinking some sort of contact with bacteria may have exacerbated her immune system. +
thotcandy  @myoclonictonicbionic i think that's just the typical SLE photosensitive malar/butterfly rash +1
dna_at  FYI it is less to do with immune complex clearance than it is to do with clearance of apoptotic debris. The overload of apoptotic autoantigens contributes to loss of tolerance -> SLE. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4764694/#S4title +2



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submitted by axsa19(9)
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C1q, C1r, and C1s form the C1 complex. Any time you see C1 with any of these three letters "qrs" think of C1 which is the first component of the classical complement pathway

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