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|MainCategory=Immunology
|MainCategory=Immunology
|SubCategory=Endocrine
|SubCategory=Endocrine
|Prompt=
|Prompt=A 24-year-old female presented to her primary care physician for chronic fatigue. She is a graduate student and has always been very active until a few months ago when she started to get tired and sleepy more than usual. The patient reported that she is very sad because she is not as active as usual, and also because she has been gaining weight. The review of system revealed chronic constipation and cold intolerance.
 
A 24-year-old female presented to her primary care physician for chronic fatigue. She is a graduate student and has always been very active until a few months ago when she started to get tired and sleepy more than usual. The patient reported that she is very sad because she is not as active as usual, and also because she has been gaining weight. The review of system revealed chronic constipation and cold intolerance.


Which of the following mechanisms is involved in the patient’s condition?
Which of the following mechanisms is involved in the patient’s condition?
 
|Explanation=The patient's symptoms of fatigue, depression, weight gain, chronic constipation and cold intolerance are suggestive of [[hypothyroidism]].  The most common cause of hypothyroidism in this age group is [[Hashimoto]]'s disease.  Hashimoto's disease is caused by anti-TPO and it is considered a form of type III hypersensitivity.
|Explanation=The patient's symptoms of fatigue, chronic constipation and cold intolerance are suggestive of [[hypothyroidism]].  The most common cause of hyperthyroidism in this age group is Hashimoto's disease.  Hashimoto's disease is caused by anti-TPO and it is considered a form of type IV hypersensitivity.


Educational Objective:
Educational Objective:
 
[[Hashimoto's]] disease, a cause of [[hypothyroidism]], is a type IV hypersensitivity; whereas Grave's disease, a cause of hyperthyroidism, is a type II hypersensitivity condition; whereas
Grave's disease, a cause of hyperthyroidism, is a type II hypersensitivity condition; whereas [[Hashimoto's]] disease, a cause of [[hypothyroidism]], is a type IV hypersensitivity.
|AnswerA=Hypersensitivity type I
|AnswerA=Hypersensitivity type I
|AnswerAExp=Type I hypersensitivity disorders include [[anaphylaxis]], [[atopy]] and [[allergy]].  Grave's disease is not a type I hypersensitivity disorder.
|AnswerAExp=Type I hypersensitivity disorders include [[anaphylaxis]], [[atopy]] and [[allergy]].  Hashimoto's disease is not a type I hypersensitivity disorder.
|AnswerB=Hypersensitivity type II
|AnswerB=Hypersensitivity type II
|AnswerBExp=Grave's disease is caused by antibodies against TSH receptors and it is considered a form of type II hypersensitivity because Grave's disease involves an antibody against a specific antigen.
|AnswerBExp=Hashimoto's disease is a type IV hypersensitivity disorder.  It should not be confused with Grave's disease which is considered a form of type II hypersensitivity because Grave's disease involves an antibody against a specific antigen.
|AnswerC=Hypersensitivity type III
|AnswerC=Hypersensitivity type III
|AnswerCExp=Hypersensitivity type III disorders include conditions where an antigen-antibody complex forms and activates the complement system.  Grave's disease is not a type III hypersensitivity disorder.
|AnswerCExp=Hypersensitivity type III disorders include conditions where an antigen-antibody complex forms and activates the complement system.  Hashimoto's disease is not a type III hypersensitivity disorder.
|AnswerD=Hypersensitivity type IV
|AnswerD=Hypersensitivity type IV
|AnswerDExp=Hypersensitivity type IV disorders include conditions characterized by delayed T-cell mediated immune reactions such as [[contact dermatitis]], [[tuberculosis]] testing and delayed transplant rejection.  Grave's disease is not a type III hypersensitivity disorder.
|AnswerDExp=Hypersensitivity type IV disorders include conditions characterized by delayed T-cell mediated immune reactions such as [[contact dermatitis]], [[tuberculosis]] testing and delayed transplant rejection and Hashimoto's disease.
|AnswerE=Not a hypersensitivity disorder
|AnswerE=Not a hypersensitivity disorder
|AnswerEExp=Grave's disease is a type II hypersensitivity disorder.
|AnswerEExp=Hashimoto's disease is a type IV hypersensitivity disorder.
|RightAnswer=B
|RightAnswer=B
|WBRKeyword=Hypersensitivity, Grave's disease
|WBRKeyword=Hypersensitivity, Grave's disease
|Approved=No
|Approved=No
}}
}}

Revision as of 00:43, 23 September 2013
Author [[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Immunology
Sub Category SubCategory::Endocrine
Prompt [[Prompt::A 24-year-old female presented to her primary care physician for chronic fatigue. She is a graduate student and has always been very active until a few months ago when she started to get tired and sleepy more than usual. The patient reported that she is very sad because she is not as active as usual, and also because she has been gaining weight. The review of system revealed chronic constipation and cold intolerance.

Which of the following mechanisms is involved in the patient’s condition?]]

Answer A AnswerA::Hypersensitivity type I
Answer A Explanation [[AnswerAExp::Type I hypersensitivity disorders include anaphylaxis, atopy and allergy. Hashimoto's disease is not a type I hypersensitivity disorder.]]
Answer B AnswerB::Hypersensitivity type II
Answer B Explanation AnswerBExp::Hashimoto's disease is a type IV hypersensitivity disorder. It should not be confused with Grave's disease which is considered a form of type II hypersensitivity because Grave's disease involves an antibody against a specific antigen.
Answer C AnswerC::Hypersensitivity type III
Answer C Explanation AnswerCExp::Hypersensitivity type III disorders include conditions where an antigen-antibody complex forms and activates the complement system. Hashimoto's disease is not a type III hypersensitivity disorder.
Answer D AnswerD::Hypersensitivity type IV
Answer D Explanation [[AnswerDExp::Hypersensitivity type IV disorders include conditions characterized by delayed T-cell mediated immune reactions such as contact dermatitis, tuberculosis testing and delayed transplant rejection and Hashimoto's disease.]]
Answer E AnswerE::Not a hypersensitivity disorder
Answer E Explanation AnswerEExp::Hashimoto's disease is a type IV hypersensitivity disorder.
Right Answer RightAnswer::B
Explanation [[Explanation::The patient's symptoms of fatigue, depression, weight gain, chronic constipation and cold intolerance are suggestive of hypothyroidism. The most common cause of hypothyroidism in this age group is Hashimoto's disease. Hashimoto's disease is caused by anti-TPO and it is considered a form of type III hypersensitivity.

Educational Objective: Hashimoto's disease, a cause of hypothyroidism, is a type IV hypersensitivity; whereas Grave's disease, a cause of hyperthyroidism, is a type II hypersensitivity condition; whereas
Educational Objective:
References: ]]

Approved Approved::No
Keyword WBRKeyword::Hypersensitivity, WBRKeyword::Grave's disease
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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