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Test your knowledge!

4223 Views 14 Replies 10 Participants Last post by  Hitman
Hello all! This is the first thread I've actually started. So, my school has a Problem Based Learning curriculum, and part of what we do is make up board-style questions for our groups based on our readings. I thought I'd share the ones I've written here - an extra question never hurts, they aren't from any qbank so there are no spoilers, and it's kind of fun quizzing each other. Here's the first one:

A 43-year-old white male presents with jaundice of several days' duration. He reports mild fatigue and "all-over itchiness". His medical history is significant for ulcerative colitis, frequent headaches, and sleep apnea. ERCP confirms a diagnosis of primary sclerosing cholangitis. Typical antibody findings would include ANA, anti-smooth muscle, and:
  • Anti-HepBc IgG
  • Anti-glycoprotein 210 antibody
  • Anti-topoisomerase antibody
  • Atypical p-ANCA antibody
  • Von Meyenburg complexes
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Answer: D. Atypical p-ANCA antibody.

Perinuclear anti-neutrophil cytoplasmic antibodies (p-ANCA) are found in up to 80% of PSC patients - they are atypical, according to Robbins, because they are directed against a nuclear envelope protein insted of myeloperoxidase; however, the histologic appearance is the same as other p-ANCAs.
  • p-ANCAs are also found in patients with Churg-Strauss syndrome (50%), microscopic polyangiitis (60%; rarely positive in polyarteritis nodosa now that PAN and MPA are classified as different diseases, but might still be associated on the boards), Kawasaki disease, glomerular basement membrane disease, rheumatoid arthritis (especially JRA), IBD (Crohn's and ulcerative colitis), and drug-induced vasculitis.
    • 75-90% of PSC patients have IBD
      • 87% of these ulcerative colitis
      • 13% with Crohn colitis
  • c-ANCA is associated with Wegener's granulomatosis
  • anti-HepBc IgG (A) are indicative of past Hepatitis B infection
  • anti-glycoprotein 210 (B) is found in primary biliary cirrhosis
  • anti-topoisomerase (C) is found in systemic scleroderma
  • Von Meyenburg complexes (E) are not immune complexes; rather, they are clinically non-significant fibrous clusters that can look like like liver metastases.
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This is really awesome man. The structure of the question is so well versed, it feels like a Kaplan or UW question. I really advise you to think seriously about starting your own online qbank company
PS- my answer is p-ANCA :D
Thanks for the compliment! I think I'll be pretty busy for the next several years, though! :rolleyes:

I'll try to put up a question every day or two. :)
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that was a very good question. so is it like a thread where any body can post their questions? or its just u?:) cause i have a couple of questions myself...
Put them up! It seems like people have been starting a new thread in the Step 1 Forum with each question rather than adding to the same thread. The admins are quite diligent about tagging posts, so don't worry about getting lost in the shuffle - we can always search for threads tagged "step-1-question"...
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