WBR0466
| Author | [[PageAuthor::Rim Halaby, M.D. [1] (Reviewed by Alison Leibowitz)]] |
|---|---|
| Exam Type | ExamType::USMLE Step 1 |
| Main Category | MainCategory::Immunology |
| Sub Category | SubCategory::Neurology, SubCategory::Renal |
| Prompt | [[Prompt::A 40-year-old Caucasian female presents to the physician's office with complaints of an episode of double vision. The patient had a similar episode 4 weeks prior to presentation, which also self-resolved. Physical examination and neurological exam appear to be normal, but a cranial MRI demonstrates several periventricular plaques. Which of the following 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 frequently 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 frequently 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, frequently characterized by lymphocytic infiltratoin with germinal centers of the thyroid gland, is associated with HLA-DR5 subtype.]] |
| Answer D | AnswerD::Antibodies against glomerular basement membrane (anti-GBM) |
| Answer D Explanation | [[AnswerDExp::Goodpasture's syndrome, frequently characterized by antibodies against glomerular basement membrane (anti-GBM), is considered a pulmorenal syndrome because it affects the lungs and the kidneys' basement membranes. Goodpasture's syndrome, similar to MS, is associated with HLA-DR2 subtype.]] |
| Answer E | AnswerE::Antibodies against parietal cells of the stomach |
| Answer E Explanation | [[AnswerEExp::Pernicious anemia, frequently characterized by antibodies against parietal cells of the stomach, is an autoimmune cause of vitamin B12 deficiency. Pernicious anemia is associated with HLA-DR5, similarly to Hashimoto thyroiditis.]] |
| Right Answer | RightAnswer::D |
| Explanation | [[Explanation::Multiple sclerosis (MS), an autoimmune neurological disease, is characterized by episodic demyelination of oligodendrocytes in the central nervous system (CNS) and axonal destruction in the peripheral nervous system (PNS), which gradually debilitates the patient until death. MS frequently affects middle-aged Caucasian females and manifests as numerous periventricular plaques upon cranial MRI. MS is associated with HLA-DR2.
Several immunologic diseases are associated with different HLA-subtypes. The HLA-DR2 subtype is associated with MS, hay fever, systemic lupus erytheromatosus (SLE), and Goodpasture's syndrome, characterized by antibodies against glomerular basement membranes (anti-GBM). |
| Approved | Approved::Yes |
| Keyword | WBRKeyword::goodpasture's syndrome, WBRKeyword::anti-GBM, WBRKeyword::glomerular, WBRKeyword::antibody, WBRKeyword::autoimmune, WBRKeyword::HLA subtype, WBRKeyword::HLA-DR2, WBRKeyword::multiple sclerosis, WBRKeyword::MS, WBRKeyword::periventricular plaque, WBRKeyword::MRI, WBRKeyword::neurological |
| Linked Question | Linked:: |
| Order in Linked Questions | LinkedOrder:: |