Today’s question will test your understanding of an important MSK-related disorder.
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A 34-year-old man presents to the clinic with complaints of recurrent painful oral ulcers, genital ulcers, and episodes of eye pain and redness. His temperature is 37.2°C (99°F), blood pressure is 125/85 mmHg, pulse is 88/minute, and respiratory rate is 16/minute. Laboratory studies show a normal complete blood count and a slightly elevated erythrocyte sedimentation rate. The patient also mentions that he occasionally experiences joint pain in his knees and ankles. Which of the following best describes the underlying pathophysiology of his condition?
A. Autoimmune destruction of exocrine glands
B. Accumulation of immune complexes within blood vessels
C. Overproduction of type I collagen in connective tissues
D. IgE-mediated hypersensitivity reaction to allergens
E. Infection with HLA-B27-associated bacteria
F. Abnormal proliferation of synovial cells leading to pannus formation
G. Chronic granulomatous inflammation and vasculitis
Detailed Breakdown of Answers + Correct Answer Below ⏬
ANSWER + QUESTION BREAKDOWN
The MENTAL MODEL used to answer this question comes from our detailed test-taking skills masterclass (check it out if you want to elevate your skills). Here’s how to think through this question:
Step 1. Read the last line to get to the heart of the question: “Which of the following best describes the underlying pathophysiology of his condition?”
Step 2: Is this a first-, second-, or third-order question?
Answer: 2nd order. 1st: Diagnose the condition, and 2nd: Identify the underlying pathophysiology.
Step 3: Read the vignette carefully and ask yourself: “What’s the underlying cause of this condition?”
Step 4. Look at the answer choices and select the option most closely resembling your final thought from “Step 3” above.
GENERAL ANALYSIS
The clinical presentation of the 34-year-old man with recurrent oral and genital ulcers, eye pain and redness, and joint pain is suggestive of Behçet's disease. This condition is characterized by a combination of mucocutaneous, ocular, and systemic symptoms.
ANSWER CHOICES:
CHOICE A: Autoimmune destruction of exocrine glands
Explanation: This best describes Sjögren's syndrome, which is characterized by dry mouth, dry eyes, and arthritis.
CHOICE B: Accumulation of immune complexes within blood vessels
Explanation: This best describes systemic lupus erythematosus, which would present with rash, joint pain, and kidney involvement.
CHOICE C: Overproduction of type I collagen in connective tissues
Explanation: This best describes scleroderma, which is characterized by skin thickening and Raynaud's phenomenon.
CHOICE D: IgE-mediated hypersensitivity reaction to allergens
Explanation: This best describes things like allergic reactions and asthma. The expected findings in this instance would include respiratory symptoms, itching, and hives.
CHOICE E: Infection with HLA-B27-associated bacteria
Explanation: This describes conditions like ankylosing spondylitis and reactive arthritis. The triad of findings in this vignette (oral ulcers, genital ulcers, and uveitis) is not characteristic of these conditions.
CHOICE F: Abnormal proliferation of synovial cells leading to pannus formation
Explanation: This describes rheumatoid arthritis, which does not explain the mucocutaneous and/or ocular findings
CHOICE G: Chronic granulomatous inflammation and vasculitis
Explanation: This describes Behçet's disease, which is characterized by recurrent oral and genital ulcers, uveitis or retinal vasculitis, and skin lesions.
FINAL VERDICT…
Behçet's disease is characterized by chronic inflammation and vasculitis that can affect various organs. The combination of recurrent oral and genital ulcers, eye involvement (uveitis), and systemic symptoms such as joint pain aligns with this diagnosis. The underlying pathophysiology involves immune dysregulation leading to neutrophilic infiltration and vascular inflammation.
CORRECT ANSWER: G) Chronic granulomatous inflammation and vasculitis
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That’s it for question 79!
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