tommyk
10-06-2006, 09:38 AM
Hy 2434 Big Time Immunology discovered…
70-year-old woman named Rachel Weisz comes to you with her boyfriend named Mr. Mummy because of a 3-month history of weight loss, burning sensation of the tongue, fatigue, anorexia, and poorly localized abdominal pain. She appears a bit pale. Her hematocrit is 35% with peripheral smear showing large erythrocytes and hypersegmented neutrophils. Serum folate is 3 ng/mL (normal greater that 1.9 ng/mL) and serum vitamin B12 is 80 pg/mL (normal 200-800 pg/mL). Stomach biopsy demonstrates chronic gastritis. Autoantibodies to which of the following are most likely involved in this patient's condition? What is the patient’s disease? Which vitamin has trouble being absorbed? (This is ultra high yield. There is an area of bowel affected which is related to Crohn’s, terminal ileum diseases, etc.)
1-Insulin receptor
2-Basement membrane
3-SS-A
4-SS-B
5-Intrinsic factor
ans) #5. Pt. Has pernicious anemia. This patient has pernicious anemia, in which autoimmune gastritis causes a lack of the intrinsic factor needed to absorb vitamin B12. Autoantibodies that are often present include those directed against the microsomal fraction of parietal cells and those capable of neutralizing intrinsic factor. The result is that vitamin B12 can no longer be absorbed by the terminal ileum. Since some vitamin B12 is stored in the liver, deficiency tends to develop slowly. Vitamin B12 deficiency can cause megaloblastic anemia; neurologic abnormalities that tend to begin with loss of position and vibration sense; and GI manifestations including anorexia, intermittent constipation or diarrhea, and abdominal pain. Antibodies to basement membrane are associated with Goodpasture syndrome. Antibodies to insulin receptors are associated with insulin resistance. Antibodies to SS-B occur in association with Sjögren syndrome. Antibodies to TSH receptor are associated with Graves disease.
70-year-old woman named Rachel Weisz comes to you with her boyfriend named Mr. Mummy because of a 3-month history of weight loss, burning sensation of the tongue, fatigue, anorexia, and poorly localized abdominal pain. She appears a bit pale. Her hematocrit is 35% with peripheral smear showing large erythrocytes and hypersegmented neutrophils. Serum folate is 3 ng/mL (normal greater that 1.9 ng/mL) and serum vitamin B12 is 80 pg/mL (normal 200-800 pg/mL). Stomach biopsy demonstrates chronic gastritis. Autoantibodies to which of the following are most likely involved in this patient's condition? What is the patient’s disease? Which vitamin has trouble being absorbed? (This is ultra high yield. There is an area of bowel affected which is related to Crohn’s, terminal ileum diseases, etc.)
1-Insulin receptor
2-Basement membrane
3-SS-A
4-SS-B
5-Intrinsic factor
ans) #5. Pt. Has pernicious anemia. This patient has pernicious anemia, in which autoimmune gastritis causes a lack of the intrinsic factor needed to absorb vitamin B12. Autoantibodies that are often present include those directed against the microsomal fraction of parietal cells and those capable of neutralizing intrinsic factor. The result is that vitamin B12 can no longer be absorbed by the terminal ileum. Since some vitamin B12 is stored in the liver, deficiency tends to develop slowly. Vitamin B12 deficiency can cause megaloblastic anemia; neurologic abnormalities that tend to begin with loss of position and vibration sense; and GI manifestations including anorexia, intermittent constipation or diarrhea, and abdominal pain. Antibodies to basement membrane are associated with Goodpasture syndrome. Antibodies to insulin receptors are associated with insulin resistance. Antibodies to SS-B occur in association with Sjögren syndrome. Antibodies to TSH receptor are associated with Graves disease.