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Which of the following autoantibodies is most likely to be significantly elevated in this patient? A 42-year-old woman comes to the physician with severe itching for the past 4 days. Her physical examination is significant for hepatomegaly and three xanthomas on her right lower extremity. Laboratory studies reveal a normal total bilirubin level and elevated serum cholesterol and alkaline phosphatase levels. A liver biopsy shows granulomatous destruction of medium-sized intrahepatic bile ducts.



A. Anticentromere antibodies
B. Antihistone antibodies
C. Antimitochondrial antibodies
D. Antinuclear antibodies
E. Rheumatoid factor

This question is part of

USMLE Full Length Exam 2
Asked by Hunt, Last updated: Apr 27, 2020

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2 Answers

Samantha Stewart

Love to do some charity work. Have a passion for writing and do it in my spare time

Samantha Stewart, Philanthropist, Post Graduate, Corpus Christi

Answered Jan 28, 2019

Many people have heard of antibodies, but they may not have heard of autoantibodies. Autoantibodies are created in the immune system which is known to fight infections. These autoantibodies go against the proteins. Lupus is one of the main diseases that are affected by these autoantibodies.

However, there are a bunch of different autoantibodies and they cause different ailments. If a woman has itching problems and the doctor conducts tests on her, he may find out that she has elevated serum cholesterol and alkaline phosphatase levels. The doctor may then perform a liver biopsy.

If that shows she has granulomatous destruction of medium-sized intrahepatic bile ducts, this means that her antimitochondrial antibodies are significantly elevated. Therefore, the doctor will take the right precautions.

 

John Smith

John Smith

Answered Sep 09, 2016

Antimitochondrial antibodies-27. the correct answer is c. this patient most likely has primary biliary cirrhosis, which is a chronic autoimmune liver disorder that may initially present with severe itching, hepatomegaly, and xanthomas (yellow nodules/plaques filled with lipid-laden histiocytes, often a sign of hypercholesterolemia). jaundice develops later in the disease, as hyperbilirubinemia does not occur until there is marked liver damage. the pathologic hallmark is described by the liver biopsy results in the question stem. over 90% of patients have elevated levels of antimitochondrial antibodies. answer a is incorrect. while patients with primary biliary cirrhosis may also have other autoimmune disorders, the association with anticentromere antibodies is not as strong as the association with antimitochondrial antibodies. it is worth noting that the presence of elevated levels of anticentromere antibodies is often associated with the crest variant of scleroderma. answer b is incorrect. while patients with primary biliary cirrhosis may also have other autoimmune disorders, the association with antihistone antibodies is not as strong as the association with antimitochondrial antibodies. it is worth noting that the presence of antihistone antibodies is often associated with drug induced lupus syndromes. answer d is incorrect. while patients with primary biliary cirrhosis may also have other autoimmune disorders, the association with antinuclear antibodies is not as strong as the association with antimitochondrial antibodies. answer e is incorrect. while patients with primary biliary cirrhosis may also have other autoimmune disorders, the association with rheumatoid factor is not as strong as the association with antimitochondrial antibodies. it is worth noting that the presence of elevated levels of rheumatoid factor is often associated with rheumatoid arthritis.
 

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