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Old 12-04-2011
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Skin Plant exposure causing linear eruption and vesiculation

A 34-year-old electric company worker presents to the urgent care clinic with a pruritic skin rash on his right arm. He relates the rash to recent plant exposure while doing a repair job for his company in a wooded area. Physical examination reveals a linear eruption with vesiculation. Which of the following cells would be found earliest in this patient’s skin lesion?

A. Mast cells
B. Eosinophils
C. Neutrophils
D. Macrophages
E. T lymphocytes
F. Plasma cells

Ans. in 24 hrs
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Old 12-04-2011
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T lymphocytes posion ivy
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Type 4 hypersensitivity E
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I guess it is D
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I guess mast cells..................??????????
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E. T lymphocytes
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Quote:
Originally Posted by USMLE2011m View Post
A 34-year-old electric company worker presents to the urgent care clinic with a pruritic skin rash on his right arm. He relates the rash to recent plant exposure while doing a repair job for his company in a wooded area. Physical examination reveals a linear eruption with vesiculation. Which of the following cells would be found earliest in this patient’s skin lesion?

A. Mast cells
B. Eosinophils
C. Neutrophils
D. Macrophages
E. T lymphocytes
F. Plasma cells

Ans. in 24 hrs

T lymphocytes


Linear eruption,its due to plant,with poison ivy exposure, T lymphocytes will be present because it is type 4 hypersensitivity reaction.
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Correct Answer Answer is E

The patient described in this question stem is experiencing cutaneous signs and symptoms after wild plant exposure most consistent with poison ivy dermatitis, one form of contact dermatitis. Poison ivy, poison oak, and poison sumac are all members of the same family of plants and produce a common allergenic substance. The cutaneous lesions described in the question stem — “linear eruption with vesiculation” — are quite consistent with the lesions caused by skin contact with these plants, and these affected areas are usually pruritic, erythematous and may show signs of excoriation. The lesions are most commonly linear because the plant most commonly drags along the skin as the patient walks past it unknowingly, and the formation of papules, vesicles and bullae at the exposed sites is typical.
This eruption, along with all other forms of contact dermatitis, results from Type IV (delayed-type) hypersensitivity. The antigens in the plant sap penetrate the epidermis and are taken up by Langerhans cells which subsequently present the antigen to TH cells. These TH lymphocytes then activate and lead to the formation of memory T cells. Upon reexposure to antigen, memory T lymphocytes reactivate and cause the immune response leading to the formation of signs and symptoms on the skin.
(Choice A) Mast cells and basophils along with IgE are primarily responsible for type I hypersensitivity allergic reactions. Mast cells lie in the tissue while basophils circulate in the blood. These cells express Fc receptors for IgE, and IgE acts as the primary antigen receptor for these cells. When two membrane-bound molecules of IgE bind the same antigen, “cross-linking” occurs which directly leads to release of granular contents such as histamine and heparin.
(Choice B) Eosinophils are phagocytic cells that are believed to play a role in defense against parasitic organisms.
(Choice C) Neutrophils are the primary phagocytic killers of the innate immune system and do not play a role in any of the four immune hypersensitivity reactions. They are usually the first leukocytes to arrive at a site of inflammation, and they are able to ingest and kill organisms by enzymatic and oxidative burst pathways as well as participate in antibody dependent cell mediated cytotoxicity.
(Choice D) Macrophages are the main circulating phagocytic antigen-presenting cells of the innate immune system. While macrophages work to present antigen and are frequently stimulated in type IV hypersensitivity reactions, they are not the primary cell in this response.
(Choice F) Plasma cells are the principal cells responsible for the synthesis of immunoglobulin. Immunoglobulin is directly responsible for types II and Ill hypersensitivity reactions, neither of which causes poison ivy dermatitis.
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