Review Questions

1. A 32-year-old woman comes to the physician because of a difficulty swallowing and shortness of breath on exertion. She says that these symptoms started about 6 months ago and have been getting progressively worse. Physical examination shows symmetric skin thickening of the proximal and distal extremities, face, and trunk. Bilateral basilar rales are heard on auscultation. Laboratory studies show antitopoisomerase I antibodies. Which of the following is the most likely diagnosis?

A. Permato myositis

B. Polymyositis

C. Scleroderma

D. Sjögren syndrome

E. Systemic lupus erythematosus

2. A 32-year-o)d woman comes to the physician because of palpitations and weight loss despite an increased appetite. She says that friends have recently begun to tell her that he eyes look like they are "popping out" Her blood pressure is 120/80 mm Hg, and her pulse is 86/min. Physical examination shows a stare with lid lag, an asymmetrically enlarged, lobular thyroid gland, and plaquelike, thickened lesions on the anterior aspect of her legs. Laboratory studies show an elevated level of thyroxine and an undetectable level of thyroid-stimulating hormone. Which of the following is the most likely mechanism of this disease?

A. CD4+ T-cell lymphocyte-media ted granuloma formation

B. CD 8+ T-cell lymphocytes destroying ant igen-containing cells

C. Deposition of antibody-antigen immune complexes in the thyroid gland

D. IgE-mediated release of chemical mediators from mast cells

E. IgG or IgM antibodies directed against a specific receptor

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