Quick NBME 6 question

[knuckles]

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In scleroderma, the fibrosis (xs collagen) is mediated by release of chemokines, by which of the following cell types?


endothelial cells
eosinophils
lymphocytes
platelets
mast cells
pmns


I put endothelial cells and it was wrong, so I'm leaning towards platelets releasing pdgf, but I thought the initial lesion was endothelial cells. If someone could explain the pathogenesis, I'd appreciate it. thanks a lot.

 

[lateralus]

Yeah I got this wrong as well... the answer is actually T lymphocytes... they release the cytokines that lead to collagen synthesis from fibroblasts.

 

[knuckles]

Are you sure? I can't find any solid sources online to prove this. Seems like a Uworld 15% right question, haha.

 

[dreamix]

lol just got this question wrong as well.

According to goljan chapter 3, under the pathogenesis of scleroderma, its the T lymphocytes that release the cytokines leading to the fibrosis.

Such minor details....

 

[kryptik]

i got it right by just thinking scl was an autoimmune dz so had to do with t-cell 😀

tcells release the cytokines to stimulate fibroblasts, so tcells are the source of the cytokines which is what the question seems to be asking

 

[dreamix]

I assumed a type II/III hypersensitivity against Scl-70 (topoisomerase I). Based on that, I deduced segmented neutrophils were activated by binding the Fc regions of those anti-Scl-70 antibodies leading to its release of cytokines (much like the case in p-ANCA vasculitides or SLE).

which is totally wrong, i guess lol.

 

[metallo]

i got it right by just thinking scl was an autoimmune dz so had to do with t-cell 😀

And unfortunately that's the way you have to think for a lot of Step 1 questions. It's only partly about what you know (since you can't know everything) and just as much about how good you are at educated guessing.