Multiple Oral Ulcers and Nikolsky Positive! - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 10-01-2011
USMLE Forums Master
 
Steps History: Not yet
Posts: 674
Threads: 264
Thanked 959 Times in 393 Posts
Reputation: 969
Send a message via Yahoo to ricko335
Skin Multiple Oral Ulcers and Nikolsky Positive!

42-year-old woman, of Mediterranean descent, presents with multiple oral blisters (see photograph), which she says have been present for several months, and a few cutaneous blisters on her back and buttocks that she just noticed over the past week. The bullae are fairly superficial, with the site of skin disruption clearly in the epidermis. Vesicles are fragile and some have unroofed and led to ulcerated lesions. The Nikolsky's sign is positive. Analysis of her sera indicates autoantibodies to a subfamily of cadherins with the distribution shown in the immunofluorescence image (see photomicrograph). You are asked to review the electron micrographs of the biopsy. Where would you expect to find the lesion?

Multiple Oral Ulcers and Nikolsky Positive!-teeth.jpg
click image to enlarge

Multiple Oral Ulcers and Nikolsky Positive!-histology.jpg
click image to enlarge

A. Hemidesmosome
B. Zonula adherens
C. Macula adherens
D. Gap junctions
E. Lamina densa of the basal lamina
Reply With Quote Quick reply to this message
The above post was thanked by:
aknz (10-01-2011), docusmle9 (10-04-2011), drortho (11-29-2011), usmle2011 (10-02-2011)



  #2  
Old 10-01-2011
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 623
Threads: 111
Thanked 424 Times in 264 Posts
Reputation: 434
Default

C. Macula adherens
Reply With Quote Quick reply to this message
  #3  
Old 10-01-2011
USMLE Forums Addict
 
Steps History: Step 1 Only
Posts: 157
Threads: 25
Thanked 72 Times in 46 Posts
Reputation: 82
Default

Quote:
Originally Posted by aknz View Post
C.
Macula adherens

can you please explain this.
Reply With Quote Quick reply to this message
  #4  
Old 10-01-2011
USMLE Forums Scout
 
Steps History: Not yet
Posts: 62
Threads: 5
Thanked 23 Times in 14 Posts
Reputation: 33
Default

It's pemphigus vulgaris - autoimmune skin disorder with IgG against desmosomes (macula adherens), shows immunofluorescence throughout epidermis. Displayed in the picture is acantholysis - intraepidermal bullae involving the skin and oral mucosa. Nikolsky sign - outer epidermis separates from basal layer with minimal pressure, used to differentiate from bullous pemphigoid.
Reply With Quote Quick reply to this message
The above post was thanked by:
aknz (10-01-2011), doc Mm (10-01-2011)
  #5  
Old 10-01-2011
USMLE Forums Scout
 
Steps History: Not yet
Posts: 55
Threads: 21
Thanked 10 Times in 10 Posts
Default

C Macula adherens / Pemphigus vulgaris
Reply With Quote Quick reply to this message
The above post was thanked by:
aknz (10-01-2011)
  #6  
Old 10-01-2011
USMLE Forums Veteran
 
Steps History: ---
Posts: 250
Threads: 19
Thanked 43 Times in 39 Posts
Reputation: 53
Default

so the answer is c?
Reply With Quote Quick reply to this message
  #7  
Old 10-01-2011
USMLE Forums Master
 
Steps History: Step 1 Only
Posts: 566
Threads: 25
Thanked 522 Times in 263 Posts
Reputation: 532
Default

Yes, it is Antibodies against Desmosome which relay at Macula Adherens .. Pemphigus Vulgaris.
__________________
Nothing is Impossible, the Word Itself says "I'm Possible"
Reply With Quote Quick reply to this message
  #8  
Old 10-02-2011
mayursn39's Avatar
USMLE Forums Addict
 
Steps History: 1+CK+CS
Posts: 189
Threads: 20
Thanked 506 Times in 99 Posts
Reputation: 516
Smile

Its pemphigus vulgaris with ab against desmoglein or desmosomes
c) Macula adherens = desmosomes.
__________________
Don`t Let Others Tell You What You Cannot Do !!!!
Reply With Quote Quick reply to this message
  #9  
Old 10-02-2011
USMLE Forums Master
 
Steps History: Step 1 Only
Posts: 512
Threads: 57
Thanked 318 Times in 163 Posts
Reputation: 328
Default

C is the answer
Reply With Quote Quick reply to this message
  #10  
Old 10-04-2011
USMLE Forums Master
 
Steps History: Not yet
Posts: 674
Threads: 264
Thanked 959 Times in 393 Posts
Reputation: 969
Send a message via Yahoo to ricko335
Default

In pemphigus vulgaris, autoantibodies to desmogleins (a member of the cadherin protein family) result in disruption of the macula adherens (desmosomes). The desmogleins are the transmembrane linker proteins of the desmosome. Specific desmogleins are the target of the autoantibodies in different forms of the disease. Cadherins are Ca2+–dependent transmembrane linker molecules essential for cell-cell contact, so their disruption in pemphigus leads to severe blistering of the skin because of disrupted cell-cell interactions early in the differentiation of the keratinocytes (epidermal cell) and excessive fluid loss. The other parts of the junctional complex: zonula occludens (answer b) and gap junctions (answer d) are not affected in pemphigus. The connections to the basal lamina, hemidesmosomes (answer a), as well as the basal lamina itself, are not part of the etiology of pemphigus. This is in contrast to bullous pemphigoid (BP), where the BP antigen causes the separation of the epithelium from the basal lamina. Cadherins are also critical molecules in the maintenance of the zonula adherens, but the autoantibodies in pemphigus are specific to the desmogleins. Pemphigus vulgaris, which is described in the clinical scenario, often begins as oral lesions and subsequently appears cutaneously. The Nikolsky sign is positive (pressure at the edge of a blister causes extension of the bulla into adjacent normal skin) in pemphigus, while in bullous pemphigoid the Nikolsky sign is negative.
Reply With Quote Quick reply to this message
The above post was thanked by:
drortho (11-29-2011)



Reply

Tags
Figures-, Histology-, Micrographs-, Pathology-, Skin-, Step-1-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Mouth Ulcers in USMLE Questions atr88 USMLE Step 2 CK Buzzwords 1 09-01-2015 03:47 PM
glucose Oral vs IV dr.muhamad USMLE Step 1 Forum 3 07-28-2011 10:21 AM
Screening before starting oral contraceptive pills docoftheworld USMLE Step 2 CK Forum 9 06-06-2011 07:48 AM
Oral Contraceptive Pills and Cardiovascular Disease hana USMLE Step 1 Forum 3 01-30-2011 07:24 PM
Mc Site of Oral squamous cell carcinoma evavar USMLE Step 1 Forum 0 12-21-2010 04:09 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)