NBME question form 6

[Cooolguy]

In crest scleroderma, the dermatological changes are caused primarily by the release of chemokines from which of the following inflammatory cell types? That is essentially the question they are asking.

They have a bunch of cell types listed: and of the answer choices I think the answer would be lymphocytes. The reason I think this is the right answer is because its an autoimmune disease and because the primary problem is in the T-lymphocytes which secrete excess cytokines which then stimulate collagen synthesis. Goljan also states that there are stimulatory antibodies toward the PDGF. (the above explanation is from goljan RR)

However, they also have the Mast cell as an answer choice which may also be the correct answer. In robbins, it states that the abnormal T-lymphocytes stimulate the mast cells and macrophages (not an answer listed in the stem) to release numerous cytokines (including IL-1, TGF-B, and PDGF) which then stimulate collagen synthesis.

Can someone please give insight on which is the correct answer. Thank You

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[jeesapeesa]

In crest scleroderma, the dermatological changes are caused primarily by the release of chemokines from which of the following inflammatory cell types? That is essentially the question they are asking.

They have a bunch of cell types listed: and of the answer choices I think the answer would be lymphocytes. The reason I think this is the right answer is because its an autoimmune disease and because the primary problem is in the T-lymphocytes which secrete excess cytokines which then stimulate collagen synthesis. Goljan also states that there are stimulatory antibodies toward the PDGF. (the above explanation is from goljan RR)

However, they also have the Mast cell as an answer choice which may also be the correct answer. In robbins, it states that the abnormal T-lymphocytes stimulate the mast cells and macrophages (not an answer listed in the stem) to release numerous cytokines (including IL-1, TGF-B, and PDGF) which then stimulate collagen synthesis.

Can someone please give insight on which is the correct answer. Thank You

endothelial cells

source: Harrison's internal medicine 16th ed, page 1981

 

[Cooolguy]

harrison's?! did you look that up or did you know it

 

[Cooolguy]

I just looked in harrison's and I am not convinced that endothelial cells is a better answer than lymphocytes or even mast cells. Goljan, harrison's, and robbins all seem to be saying different things.

 

[illixir]

Was fibroblasts an option? If they're talking strictly about the skin changes, I'd think that would actually be it. Otherwise, I'd say T lymphocytes and still might think that's better since they secrete the cytokines to make the fibroblasts make collagen.

You can always pay to get the answers, I heard you could do that with form 6.

 

[Cooolguy]

i did the exam today with the extended review--the answer is lymphocytes