WBR0466

Author	[[PageAuthor::Rim Halaby, M.D. [1]]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Immunology
Sub Category	SubCategory::Neurology, SubCategory::Renal
Prompt	[[Prompt::A 40 year old Caucasian female patient presents to her physician's office complaining of one episode of self-resolved diplopia. The patient had a similar episode 4 weeks prior to presentation that also self-resolved. Physical examination is unremarkable with a normal neurological exam. Brain MRI shows several periventricular plaques. Which of the following other disease descriptions share the same HLA subtype association as the patient's condition?]]
Answer A	AnswerA::Pencil-in-cup deformity of end joints
Answer A Explanation	AnswerAExp::Psoriatic arthritis is characterized by pencil-in-cup deformity of end joints. Psoriatric arthritis affects approximately 30% of patients with psoriasis, a disease associated with the HLA-B27 subtype.
Answer B	AnswerB::Skip lesions and granulomatous inflammation of a bowel section
Answer B Explanation	AnswerBExp::Crohn's disease is characterized by Skip lesions and granulomatous inflammation of a bowel section. Crohn's disease is a type of inflammatory bowel disease that is associated with HLA-B27 subtype.
Answer C	AnswerC::Lymphocytic infiltratoin with germinal centers of the thyroid gland
Answer C Explanation	AnswerCExp::Hashimoto thyroidis is characterized by ymphocytic infiltratoin with germinal centers of the thyroid gland. Hashimoto thyroiditis is associated with HLA-DR5 subtype.
Answer D	AnswerD::Antibodies against glomerular basement membrane (anti-GBM)
Answer D Explanation	[[AnswerDExp::Goodpasture's disease is characterized by Antibodies against glomerular basement membrane (anti-GBM). Goodpasture's disease is considered a pulmorenal syndrome because it affects the lungs and the kidneys's basement membranes. Similar to MS, it is associated with HLA-DR2 subtype.]]
Answer E	AnswerE::Antibodies against parietal cells of the stomach
Answer E Explanation	AnswerEExp::Pernicious anemia is characterized by antibodies against parietal cells of the stomach that is an autoimmune cause of vitamin B12 deficiency. Pernicious anemia is associated with HLA-DR5, similar to Hashimoto thyroiditis.
Right Answer	RightAnswer::D
Explanation	[[Explanation::Multiple sclerosis (MS) is an autoimmune neurological disease characterized by episodic demyelination of oligodendrocytes in the central nervous system (CNS) and axonal destruction in the peripheral nervous system (PNS) that gradually debilitate the patient until death. MS typically affects middle-aged Caucasian females and is characterized on brain MRI by numerous periventricular plaques. MS is associated with HLA-DR2 Several immunologic diseases are associated with different HLA-subtypes. HLA-DR2 subtype is associated with MS, hay fever, systemic lupus erytheromatosus (SLE), and Goodpasture's syndrome. The latter is characterized by antibodies against glomerular basement membranes (anti-GBM). Educational Objective: HLA-DR2 subtype is associated with multiple sclerosis (MS), hay fever, systemic lupus erytheromatosus (SLE), and Goodpasture's syndrome. Educational Objective: References: ]]
Approved	Approved::No
Keyword	WBRKeyword::goodpasture's syndrome, WBRKeyword::goodpasture, WBRKeyword::syndrome, WBRKeyword::anti-GBM, WBRKeyword::glomerular, WBRKeyword::basement, WBRKeyword::membrane, WBRKeyword::antibody, WBRKeyword::autoimmune, WBRKeyword::HLA, WBRKeyword::subtype, WBRKeyword::HLA-DR2, WBRKeyword::multiple, WBRKeyword::sclerosis, WBRKeyword::multiple sclerosis, WBRKeyword::periventricular, WBRKeyword::plaque, WBRKeyword::periventricular plaques
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