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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor={{Rim}}, {{Alison}}
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Pathology, Pathophysiology
|MainCategory=Pathology, Pathophysiology
Line 20: Line 20:
|MainCategory=Pathology, Pathophysiology
|MainCategory=Pathology, Pathophysiology
|SubCategory=Musculoskeletal/Rheumatology
|SubCategory=Musculoskeletal/Rheumatology
|Prompt=A 40-year-old female presents to her dermatologist with complaints of several skin lesions.  Upon physical examination, the physician notes several intraepidermal bullae with flaccid blisters and an epidermal layer that easily comes off with manual stroking.  Which of the following processes characterize the disease in this patient?
|Prompt=A 40-year-old female presents to her dermatologist with complaints of several skin lesions.  Upon physical examination, the physician notes several intraepidermal bullae, with flaccid blisters, and an epidermal layer that easily is removed with manual stroking.  Which of the following processes best characterizes the patient's disease?
|Explanation=Pemphigus vulgaris is an autoimmune dermatologic disease due to IgG antibodies against desmosomes that causes acantholysis, defined as loss of cohesion between the keratinocytes in the epidermal layer.  Pemphigus vulgaris is characterized by formation of intraepidermal bullae that cause flaccid blisters with positive Nicolsky's sign, defined as easy separation of epidermal layer upon manual stroking.  
|Explanation=[[Pemphigus vulgaris]] is an autoimmune dermatologic disease due to IgG antibodies against desmosomes, which cause acantholysis, the loss of cohesion between the keratinocytes in the epidermal layer.  [[Pemphigus vulgaris]] is characterized by the manifestation of intraepidermal bullae, with flaccid blisters positive for Nicolsky's sign, the easy separation of epidermal layer upon manual stroking.  
 
|EducationalObjectives= [[Pemphigus vulgaris]] is an autoimmune dermatological disease, resulting from IgG antibodies against desmosomes.
|References= First Aid 2014 page 434


Educational Objective:
Pemphigus vulgaris is an autoimmune dermatological disease characterized by IgG antibody against desmosome.
|AnswerA=IgG antibodies against desmosome
|AnswerA=IgG antibodies against desmosome
|AnswerAExp=Pemphigus vulgaris is characterized by IgG antibodies against desmosome.
|AnswerAExp=[[Pemphigus vulgaris]] results from IgG antibodies against desmosomes.
|AnswerB=IgM antibodies against desmosome
|AnswerB=IgM antibodies against desmosome
|AnswerBExp=Pemphigus vulgaris is characterized by IgG antibodies against desmosome, not IgM desmosome.
|AnswerBExp=[[Pemphigus vulgaris]] results from IgG antibodies against desmosomes, not IgM desmosomes.
|AnswerC=IgG antibodies against hemidesmosome
|AnswerC=IgG antibodies against hemidesmosome
|AnswerCExp=Bullous pemphigoid is characterized by IgG antibodies against hemidesmosome
|AnswerCExp=Bullous pemphigoid results from IgG antibodies against hemidesmosomes.
|AnswerD=IgM antibodies against hemidesmosome
|AnswerD=IgM antibodies against hemidesmosome
|AnswerDExp=Pemphigus vulgaris is not due to auto-antibodies against hemidesmosome
|AnswerDExp=[[Pemphigus vulgaris]] does not result from auto-antibodies against hemidesmosomes.
|AnswerE=IgE antibodies against hemidesmosome
|AnswerE=IgE antibodies against hemidesmosome
|AnswerEExp=Pemphigus vulgaris is not due to auto-antibodies against hemidesmosome
|AnswerEExp=Pemphigus vulgaris does not result from auto-antibodies against hemidesmosomes.
|RightAnswer=A
|RightAnswer=A
|WBRKeyword=pemphigus, vulgaris, pemphigus vulgaris, IgG, auto, antibodies, antibody, autoantibody, autoantibodies, desmosome, blisters, blisters, bullae, acantholysis, nicolsky's, nicolsky
|WBRKeyword=pemphigus vulgaris, IgG, antibodies, antibody, autoantibody, autoantibodies, desmosome, blisters, bullae, dermatology, skin, lesion
|Approved=No
|Approved=Yes
}}
}}

Revision as of 19:27, 28 July 2014

 
Author [[PageAuthor::Rim Halaby, M.D. [1], (Reviewed by Alison Leibowitz)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Pathology, MainCategory::Pathophysiology
Sub Category SubCategory::Musculoskeletal/Rheumatology
Prompt [[Prompt::A 40-year-old female presents to her dermatologist with complaints of several skin lesions. Upon physical examination, the physician notes several intraepidermal bullae, with flaccid blisters, and an epidermal layer that easily is removed with manual stroking. Which of the following processes best characterizes the patient's disease?]]
Answer A AnswerA::IgG antibodies against desmosome
Answer A Explanation [[AnswerAExp::Pemphigus vulgaris results from IgG antibodies against desmosomes.]]
Answer B AnswerB::IgM antibodies against desmosome
Answer B Explanation [[AnswerBExp::Pemphigus vulgaris results from IgG antibodies against desmosomes, not IgM desmosomes.]]
Answer C AnswerC::IgG antibodies against hemidesmosome
Answer C Explanation AnswerCExp::Bullous pemphigoid results from IgG antibodies against hemidesmosomes.
Answer D AnswerD::IgM antibodies against hemidesmosome
Answer D Explanation [[AnswerDExp::Pemphigus vulgaris does not result from auto-antibodies against hemidesmosomes.]]
Answer E AnswerE::IgE antibodies against hemidesmosome
Answer E Explanation AnswerEExp::Pemphigus vulgaris does not result from auto-antibodies against hemidesmosomes.
Right Answer RightAnswer::A
Explanation [[Explanation::Pemphigus vulgaris is an autoimmune dermatologic disease due to IgG antibodies against desmosomes, which cause acantholysis, the loss of cohesion between the keratinocytes in the epidermal layer. Pemphigus vulgaris is characterized by the manifestation of intraepidermal bullae, with flaccid blisters positive for Nicolsky's sign, the easy separation of epidermal layer upon manual stroking.

Educational Objective: Pemphigus vulgaris is an autoimmune dermatological disease, resulting from IgG antibodies against desmosomes.
References: First Aid 2014 page 434]]

Approved Approved::Yes
Keyword WBRKeyword::pemphigus vulgaris, WBRKeyword::IgG, WBRKeyword::antibodies, WBRKeyword::antibody, WBRKeyword::autoantibody, WBRKeyword::autoantibodies, WBRKeyword::desmosome, WBRKeyword::blisters, WBRKeyword::bullae, WBRKeyword::dermatology, WBRKeyword::skin, WBRKeyword::lesion
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