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Retired NBME 23 Answers

nbme23/Block 3/Question#36 (reveal difficulty score)
A 70-year-old woman comes to the physician ...
Serum sickness 🔍 / 📺 / 🌳 / 📖
tags: Immuno repeat rheum

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 +5  upvote downvote
submitted by curlycheesefriesguy(5)
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ogcinrcdA ot FA 2,109 in the ioentcs taubo ethirdomau rttaih,irs it is genvi that rudmoehiat eludsno rae deu to obdrinifi c.rsosnei In eht gaphlotyo hparcte in FA, fiioirbdn sicroesn si asdi to eb na mlpeaxe of peyt 3 eiiysrivepnhtsty acnr.toei In sith stenquio ,mest eht itetpan is asdi ot vahe ouermiadth dnoeuls adn ehyt ksa te'h imnlmcouogi scineammh fo isth t'tnapeis imoanaitnflm si simrali to ?S'o ablscayli tyeh aeskd tuoab awht tyep fo nyhrpieivttiyses cetinoar is orbndiifi .ehrnioTssec ws:raen meRuh dt-ouinrgoienbsd&li;f gc&ysnerei;potts- 3 S-mR&a;stHeg sa resmu scksi.ens toG it nwrog tw.b

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submitted by sajaqua1(607)
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erSum ciessnsk si a pTey 3 piintvryeetshiys cn,raoite in hihcw het boyd osdrnsep to cgeiniatn icadlme tnusasbesc adn pcsordue .sidoantbie These odntabiies ni atclcnuiroi ethn dnib to eth nincgaeit sgudr adn tse ffo eth mecetolpmn cadaces. utdRhieoma iatihtsrr is olas a pyTe 3 sistepyhyernivti re.otainc

A) oAtpsopis fo oghacmer-spa sopasipto si reygnlael tno a teyp of nsiirpyyevtsihet inoceart. B) Msta cel algnarntiuode- iths si tpra of a pyTe 1 esivypthietsniry xlhsiptaanrycoana/ei, in cihhw stam llsce inbd gEI no thire u,srfcae dna IgE nbidnig ot teh tatger aignent nuscied a aontalcorofinm hcgaen ni the EIg ttha sset ffo stma lcle onerid.altuagn C) laNartu eirKll llCe -lligkni yplsa a airtevy of rse,lo indignulc acecrn eorsnippuss nda ditonetrcus fo ralvily cdefenti l.cles fI ehty layp a lroe in iphsvneriiyyestt, it si rpat fo epTy 2 HRS in hwhic eyth uowdl nerdpso to gI on the lcle ruceaf.s E) eheWl adn alrfe ea-inrtcso Thsi is soal a yeTp 1 RSH.

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meningitis  I d'ndit ckip tsih noe ceuasbe I toghhtu meurS niesscks swa oot smeiystc dna AR asw a emro dlecolzai epyT 3. ig,naA mi irnginkvoeth ihst.ng +
youssefa  lno:Gaj RA is a xidme epyt III adn ytpe IV munime inetocra +9
dinagohe23  I hhgtou NK elcl lgkniil wsa srilmia to T lcel os adn AR is soal ypTe IV +7
nephcard  bll,l douosf +3
usmile1  KN clel gliinlk uwdol eb a eypt of tneian unim,miyt nto mliaisr ot emoymr T llec.s caebuse tehy idd nto iveg na mpaeexl fo a etpy 4 YHS, eth newsra must eb usrem cknissse. +

bumping the OP; extraarticular manifestations are common in RA (i.e. rheumatoid nodules in subcutaneous tissue and lung (+ pneumoconiosis --> Caplan syndrome), interstitial lung disease, pleuritis, pericarditis, anemia of chronic disease, neutropenia+splenomegaly (Felty syndrome), AA amyloidosis, Sjogren syndrome, scleritis, carpal tennel syndrome. (btw I thought RA was local and HSR II)



 +2  upvote downvote
submitted by eli_medina9(22)
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ybeaM heyt wnte ithw ursem nksseisc a( yept III yesesinhtivtpiyr rn)x no ihts oisenutq bdeas on eth ysooergl uesd ot aenogdis R.A Pts with RA have eaidsnibot ot nlibmomnguuloi G (gG,I) celdal odtearhimu fstcroa (.FsR) It kasme emso nssee atht nopu these hmotradiue asrofct rtgceina twhi l"es"f acguniirctl g,IG imenmu lsexcpmoe wdoul omfr tath dulow retla editsop in ssesuit nep(naiixgl in rtap teh riaurtatlraexc tafisasntnomie eens wiht R,A e.x iohtruedma loendsu, eplr,iiuts srdiariietcp ct.)e.

pncticiyneic:nr.ttd/tndedt-rtniei-/hcweasveepttywieiwi-rhisps//epys./oymcscesmidtioi-

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Serum sickness—the prototypic immune complex disease. Antibodies to foreign proteins are produced and 1–2 weeks later, antibody- antigen complexes form and deposit in tissues = complement activation = inflammation and tissue damage. Fever, urticaria, arthralgia, proteinuria, lymphadenopathy occur 1–2 weeks after antigen exposure. Serum sickness-like reactions are associated with some drugs (may act as haptens, eg, penicillin) and infections (eg, hepatitis B).



 +0  upvote downvote
submitted by imgdoc(183)
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RA si a epty 3 itnirestysvphiye ariocent chhwi has tow etpm.noonsc

  1. DC 4+ T llces lliw rieilnttfa stusei nda rcate ot astgtnaeouin epensrt ni het vsialnyo on,jti tsih ussace Thlap-FaN and 1-IL ot be daerle.se Thees tormimnfylaa eosikctny iwll caeus eth iatiiln rmmltoaynifa iacotenr. eeshT stcokneiy SALO iaevttac B lels.c

  2. B selcl purcode hmtdirauoe aftorc sa ewll sa inta ciclcy litlnrdauicte ppeidet aotdybi.n yheT dnbi eht iaontunsaetg and morf MEMINU eoscpmlxe taht spitedo no teh ui.ovnsmy yeTh ucesa ompltcmene to be .avcaittde ecneH hte lcssica Tpye 3 eiyshretsnpiivty ,rtnicoae ti si osmcodep fo 3 singth: 1. annitge 2. itdanoyb .3 tepenocmlm

t,xeN uyo ende to nkwo hatt ersmu snikessc ()AF si SLAO a yetp 3 etyviehpytiisrsn naetcroi, sith emti it si edu ot cinilielpn or a loonanocml anoyi,dtb aslablyci esmo ceintigan ru,dg hhciw ausces iynbatdo to nbdi adn hnte seoidpt neo.mtecplm

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submitted by namesthegame22(13)
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Teyp III siersttnyipevhiy si eindfde yb eht epsreenc of clgitarcnui pibonontycegmetamniedn-lat- xelscmepo hatt peotsid in stuessi and ueasc filinmnaaotm dna cut.osrdntei he(s ahd dceersdae C3)

ypet III ntyehyetsiivrpsi antisore:c S,LE resmu ssiscekn ro,natcie teisliaortyrp da(sAnP,Noo) dan gs.eoposrtosmGhnlrlcuP(lieo-p)ateociSrttc-pN RA is losa a miedx peyT 3 and ypeT 4 HRS.

Sruem isenkssc corusc wnhe a gudr, ushc as hetayocytmnti- ulgb,nloi csta as a tnpahe to teh ienmum ,tsemys grniiggert ndabyoti ni.aomtfor euSrm ssneikcs cteiarno ylusual occrus 1 to 2 kesew atefr het atiiinl pseoruex ot het ,urdg gcfrlteien het time qerueird to munot an mmnieu sorepn.se ehT ioandbtise enth bind hte g,rdu ositped in e,sutis dna rttcata nad tcveatai eotlpmc.men hTe tlresu is fere,v srah, nad .srlarhagait

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