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  #1  
Old 05-09-2014
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Question Nbme 16 q

1. a 24 yo f was stung on her right thumb by a bee 30 minutes ago. she develops an urticarial lesion at the site of the sting 6 hrs later, the area has become indurated and firm. which of the following explains the induration at the site of the sting?

a. decrease in the expression of the adhesion molecules on vascular endothelial cells
b. decrease in derum c reactive protein concentration
c. infulx of macrophages producing interleukin 1(IL1), IL6, and tumor necrosis factor alpha
d. lysis of endothelial cells by the alternative complement pathway
e. vasoconstriction

please someone explain why the answer is MACROPHAGES C.
this is type I HS, how do macrophages come here?? what page in FA is this? or goljan or whatever to study this cause i cant seem to find it anywhere.

IF they are saying that is INDURATED i thought that due to the reaction that has pass decreased expression of the adhesion molecules would let the fluid in the interstitial space "stuck" in there, specially if it is on a SENSITIZED person (in a non sensitized it makes sense macrophages as they are the APCS) thats why it stays indurated (papule) please someone correct this logic.

thanks in advance guys.
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Old 05-09-2014
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This doesn't sound like a type I HS because the time frame of 6 hours is consistent with a Type 4 or delayed type hypersensitivity reaction. Think of the induration as being similar to a PPD or candidal extract reaction.
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Quote:
Originally Posted by qirkergaard View Post
This doesn't sound like a type I HS because the time frame of 6 hours is consistent with a Type 4 or delayed type hypersensitivity reaction. Think of the induration as being similar to a PPD or candidal extract reaction.
i thought type 4 took 24h to 72h? that is why is "delayed" from what ive studied....
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Old 05-10-2014
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Type 1 hypersensitivity - immediate ( min )
Delayed ( after 2-4 hr )
Delayed reaction is due to release of cytokines and here macrophages are the one releasing acute phase cytokines -IL 1,6 ;TNF alpha
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I meant type 1 hypersensitivty has 2 divisions 1st is immediate 2nd is delayed
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Quote:
Originally Posted by synaptobrevin View Post
I meant type 1 hypersensitivty has 2 divisions 1st is immediate 2nd is delayed
oh that makes sense.
thank you.
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Old 05-10-2014
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Oh yes, that clarified it for me too!
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Old 05-11-2014
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which nbme is the best to start off with. ?? people recommend the latest ones but most people do nbme 7
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Old 05-15-2014
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Start with the oldest, work towards the newest. I did 7, 11, and 12. A lot of people seem to be recommending 16, but I'm not made of money, so I stopped after 12.
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Old 05-15-2014
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Quote:
Originally Posted by monkeymind90 View Post
Start with the oldest, work towards the newest. I did 7, 11, and 12. A lot of people seem to be recommending 16, but I'm not made of money, so I stopped after 12.
totally agree!! same problem here.. is 7 still reliable when compared to 15?
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Old 05-15-2014
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I haven't taken it, but I have heard that 7 is still good. As for reliable, this is how I think of it. Under no circumstances am I going to delay my exam, and under no circumstances am I going to do anything less than my best.

Does it really matter how predictive the exam is of your score? The point is not to bask in your awesome ability, but instead to identify your weaknesses and improve. So I don't really know or care how reliable it is. I did learn a lot from it.
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Old 05-15-2014
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Hey !!

IL 1 IL 6 and TNF alpha induce expression of selectins and ICAM s on endothelial cells so inflamatory cells( Neutrophils Basophils Eosinophils) can migrate tissue and start inflamation process. This is what i remember from goljan
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