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NBME 21 Answers

nbme21/Block 2/Question#23 (reveal difficulty score)
A 4-year-old boy with chronic granulomatous ...
Macrophages producing interleukin-1 (IL-1) ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: Immuno repeat

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submitted by โˆ—trazobone(97)
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I was so fixated on the fact that in a TB granuloma, macrophages produce IL12 or TNFalpha, not IL1. So I eliminated C and clicked B, even tho itโ€™s not CD4 lymphocytes that produce TNFalpha. But the fact that macrophages produce IL1 still didnโ€™t make any sense.

I couldnโ€™t find any explanation in first aid for this (it doesnโ€™t tell you what cells secrete IL1), but according to my notes from an immuno lecture I half paid attention to, IL1 is a cytokine of innate immunity secreted by monocytes, macrophages, endothelial cells, and epithelial cells; so basically everybody. This goes in conjunction with everything that FA says (FA18 p. 108)

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makingstrides  Macrophages secrete Il-1,6,8,12 and TNF - alpha. In this scenario, the patient is Il-12 receptor deficient. When macrophages engulf an object, it releases Il-12 to stimulate T-lymphocytes, that in return, release Ifn-gamma, which would convert the macrophage into an epithiliod histiocyte. +4
abk93  making strides is a baller Thank you +
abk93  why is this patient il-12 deficient? +2



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submitted by โˆ—abk93(8)
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Specifically, what is the purpose of Il-1 in this question?

is it just that macrophages make Il-1?

doesn't appear to be involved in granuloma formation.

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submitted by โˆ—usmle11a(102)
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IFN y will inhibit differentiation of Th2 cells and therefore (a,e wrong) b) regulatory T cells d) if the case was talking about virus

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teepot123  fa 19 pg 108 +



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submitted by โˆ—meryen13(48)
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interferon gamma will do a few things in body--> 1 activate macrophages to kill! or to become epitheliod histiocyte to wall off infections. 2- it will increase the mac molecules on the surface of the cells. 3. it inhibits differentiation of t cell to th2 cell because th2 has anti inflammatory (il-10 secretion) and eosinophilic activation function. 4. also activated the nk cells to start killing!

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bbr  and (just for completeness), promotes Th1 +
ege  what does "Mac" stand for? "it will increase the mac molecules of the surface of the cells." Thanks! +
saqeer  mac= membrane attack complex +2



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submitted by โˆ—temmy(152)
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IFN gamma stimulates macrophages to produce granulomas

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submitted by โˆ—jatsyuk38(2)
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doesn't IFN-gamma upregulate MHCII? Which would activate T lymphocytes to produce cytokines? I do get why macrophages is the better answer, but didn't understand what IL-1 had to do with anything...

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