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{{WBRQuestion
{{WBRQuestion
|QuestionAuthor={{Rim}}
|QuestionAuthor={{Rim}} {{Alison}}
|ExamType=USMLE Step 1
|ExamType=USMLE Step 1
|MainCategory=Immunology
|MainCategory=Immunology
Line 20: Line 20:
|MainCategory=Immunology
|MainCategory=Immunology
|SubCategory=Endocrine
|SubCategory=Endocrine
|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.
|Prompt=A 24-year-old female presents to the physician's office for complaints of chronic fatigue. She explains that she was highly active until a few months ago when she began to get excessively tired and sleepy. The patient reports 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 most likely 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]], likely caused by [[Hashimoto]]'s disease.  Hashimoto's disease is caused by anti-TPO and is considered a form of type III hypersensitivity.


Which of the following mechanisms is involved in the patient’s condition?
|EducationalObjectives= The patient's symptoms of fatigue, depression, weight gain, chronic constipation, and cold intolerance are suggestive of [[hypothyroidism]], likely caused by [[Hashimoto]]'s disease.  Hashimoto's disease is caused by anti-TPO and is considered a form of type III hypersensitivity.
|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.
|References= First Aid 2014 page 320


Educational Objective:
|AnswerAExp=Type I hypersensitivity disorders include [[anaphylaxis]], [[atopy]], and [[allergy]].  Hashimoto's disease is not a type I hypersensitivity disorder.
[[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.
|AnswerA=Hypersensitivity type I
|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=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 the pathophysiology of Grave's disease involves an antibody against a specific antigen.
|AnswerBExp=Hashimoto's disease is a type IV hypersensitivity disorder.  Grave's disease is considered a form of type II hypersensitivity, because the pathophysiology of 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.  Hashimoto'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 and Hashimoto's disease.
|AnswerDExp=Hypersensitivity type IV disorders include conditions characterized by delayed T-cell mediated immune reactions such as [[contact dermatitis]], [[tuberculosis]] testing, delayed transplant rejection, and Hashimoto's disease.
|AnswerE=Not a hypersensitivity disorder
|AnswerE=Not a hypersensitivity disorder
|AnswerEExp=Hashimoto's disease is a type IV hypersensitivity disorder.
|AnswerEExp=Hashimoto's disease is a type IV hypersensitivity disorder.
|RightAnswer=B
|RightAnswer=B
|WBRKeyword=Hypersensitivity, hypothyroidism, Hashimoto
|WBRKeyword=Hypersensitivity, hypothyroidism, Hashimoto, immune, fatigue, depression, immune system,
|Approved=No
|Approved=Yes
}}
}}

Revision as of 18:36, 29 July 2014
Author [[PageAuthor::Rim Halaby, M.D. [1] (Reviewed by Alison Leibowitz)]]
Exam Type ExamType::USMLE Step 1
Main Category MainCategory::Immunology
Sub Category SubCategory::Endocrine
Prompt [[Prompt::A 24-year-old female presents to the physician's office for complaints of chronic fatigue. She explains that she was highly active until a few months ago when she began to get excessively tired and sleepy. The patient reports 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 most likely involved in the patient’s condition?]]
Answer A AnswerA::
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. Grave's disease is considered a form of type II hypersensitivity, because the pathophysiology of 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, 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, likely caused by Hashimoto's disease. Hashimoto's disease is caused by anti-TPO and is considered a form of type III hypersensitivity.

Educational Objective: The patient's symptoms of fatigue, depression, weight gain, chronic constipation, and cold intolerance are suggestive of hypothyroidism, likely caused by Hashimoto's disease. Hashimoto's disease is caused by anti-TPO and is considered a form of type III hypersensitivity.
References: First Aid 2014 page 320]]

Approved Approved::Yes
Keyword WBRKeyword::Hypersensitivity, WBRKeyword::hypothyroidism, WBRKeyword::Hashimoto, WBRKeyword::immune, WBRKeyword::fatigue, WBRKeyword::depression, WBRKeyword::immune system
Linked Question Linked::
Order in Linked Questions LinkedOrder::
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