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* Help! NBME 11 endocrine question
  linth - 05/02/11 09:02
  A 6 year-old girl is brought to the physician by her mother because of a 2-week history of increased thirst and a 3-kg weight loss. Her mother says that the patient is constantly drinking water. She is at 75th percentile for height and 50th percentile for weight. Physical examination shows tachypnea and dehydration. Laboratory examination shows hyperglycemia, metabolic acidosis and ketonemia. if a biopsy specimen were obtained from this patient's pancreas, which of the following findings in islet cells would now be most likely?

A: basement membrane thickening of capillaries
B: cellular necrosis and lymphocyte infiltration
C: Decrease in mass and deposition of amyloid
D: large beta cell and nuclei
E: marked atrophy and fibrosis

I think of DM type 1, and choose E ( I remember DM type 1 is fibrosis, while DM type 2 is amyloidosis). but the extended feedback told me it's incorrect.... I really can think of nothing else to choose...please help...
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* Re:Help! NBME 11 endocrine question
  bubu7 - 05/02/11 09:28
  As i know DM type 1 is Islet lymphocytic Infiltration and DM type 2 is Islet Amyloid deposition........  
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* Re:Help! NBME 11 endocrine question
  dna23 - 05/02/11 09:55
  I think the answer is B this in integrated question, Patho, micro, endocrine, when the pancreas is afected, What type of necrosis? "Fat Necrosis" in DM type I What is the possible cause? Coxackie virus hx; then you get lymphocyte infiltration  
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* Re:Help! NBME 11 endocrine question
  linth - 05/02/11 18:39
  Thanks dna23...I guess B should be the answer then.

I searched it on internet and DM type 1 do have islet lymphocyte filtration. But fat necrosis... isn't it in acute pancreatitis?
and I still remember from Goljan that DM type 1 has fibrosis and DM type 2 has amyloidosis...

anyone who listened to Goljan?... I'm really confused...
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* Re:Help! NBME 11 endocrine question
  antonella - 05/02/11 18:58
  bbbbbbbbbtype DM type 1 with DKA  
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* Re:Help! NBME 11 endocrine question
  syr - 05/02/11 19:28
  it's bbbb  
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* Re:Help! NBME 11 endocrine question
  saphire - 05/02/11 20:16
  B.....> diabetic presentation with DKA is --> type 1 DM----> it is a type 4 hypersesitivity reaction ----> this is the only one out of the hypersensitivity reaction with the lyphocyte involment ---> all else are immunoglobin mediated ---> delayed type : T-cell mediated
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* Re:Help! NBME 11 endocrine question
  sukeshmanthri123 - 05/04/11 11:46
  type 1 DM patients have auto immune destruction of pancreas u need to choose lyphocytic infiltration ( choice b )
acute pancreatitis causes fat necrosis but not type 1
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* Re:Help! NBME 11 endocrine question
  drnash - 05/04/11 15:04
  but i think by age 6 isnt the Islet area of Pancreas in the child fully destroyed[mediated by lymphocytes]and replaced by fibrous tissue finally?but i think Coxsackie virus infection triggered the autoantibodies release[trigger for autoimmune attack for the first time in her life] and hence in the present state her IsletCells have been attacked by Lymphocytes and hence B is the answer.isnt it?  
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* Re:Help! NBME 11 endocrine question
  cholinergic - 06/24/15 10:19
  But even with lymphocyte attack, isn't the mechanism of killing APOPTOSIS eg by perforin/granzyme rather than NECROSIS? Necrosis is caused by ENZYMATIC degradation and protein denaturation due to an external cause and in the case of Coxsackie it would elicit the cell-mediated immunity which would kill infected host cells, no?  
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