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Kaplan Qbank USMLE



Author12 Posts
  #1

A 35 yr old woman consults an ophthalmologist bcz of double vision and droopy eyelids.She also has complaints of generalized muscle weakness .IV injection of edrophonium dramatically but only briefly reverses her symptoms.The pt probable disease has a pathophysiologic basis that is closest to that of which of the following>

a.bullous pemphigoid

b.DM type 1

c.idiopathic addisons disease

d.insulin resistance

e.SLE


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  #2

i donbt remember immuno very well but ill guess a.

i think it correseponds to type 2 hypersensitivity.


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  #3

actually this i sa confusing q. in sle both type 2 and 3 were involved.

insulin resistence cud be attributed to auto ab but this uwas nto 100 % shown i think.

c probably involves type 4 rxn


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If you yourself are at peace, then there is at least some peace in the world.

  #4

its definitely insulin resistance![if considering treatment response] as giving insulin to such patients lowers the glucose level [increase substrate conc.] ; same is the mechanism of improvement in pts with myasthenia gravis with edrophonium!

from an immunologican point of view it cud be A or E

but i guess i'll go with d!


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  #5

It is Insulin resistence -sure nod

  #6

i know most common cause is hyperparathyroidism. can anything else be added to this topic.

  #7

yes its insulin resistance as U all said.it is antibodies against insulin receptors as compared to antibodies against ach receptors...(I am not so convinced with this)..

SLE is due to circulating immune complexes.DM type 1 and idiopathic addisons is due to humoral responses.and bullous pemphigoid is due to antibodies against basement membrane.

hey guys!is type 1 DM due to antibodies or type 2.can someone recall and revise this?`


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live and let live.

  #8

sorry i wanted to post abt "ASx hypercalemia etilogy" in forum ,anyways can u add on anyone,pls

  #9

i never knew tht type II DM has some relation with antibodies against the receptor but anyway insulitis is a predominant feature of type I, and type II is basically insulin resistance for a variety of reasons!

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  #10

d

mentioned in Kaplan's

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  #11

i also think it is D. cos type 2 dm is associated with ab against insulin receptors (type 2 hypersens).just as myasthenia gravis is ab against ach receptors, same as graves.

pemphigus vulgaris is the other one that is type 2 non cytotoxic. i dont know about pemphigoid.

type 1 dm is t cell mediated in type 4 reaction. there are antibodies against islet cells.

sle also gives type 2 reaction but it will be of the cytotoxic kind cos that is the one associated with production of immune complexes. the main sle reactions are type 3.


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  #12

bullous pemphigoid is type 2 as well.

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