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Medicine -2

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medmaestro's version from 2015-11-29 18:23

Section

Some HLA & DR
Question Answer
Psoriasis vulgarisHLA Cw6
ABACAVIR hypersensitivityHLA-B57
Acute anterior uveitisHLA-B27
Adrenal insufficiencyHLA-DR3
Ankylosing spondylitisHLA-B27
Behcet’s diseaseHLA-B51
Bullous PemphigoidHLA DQ7
Chronic Active HepatitisHLA-DR3
Dermatitis HerpetiformisHLA-DR3
Gluten sensitive enteropthy(Coeliac disease)HLA-DQ2
Good Pasture SyndromeHLA-DR2
Grave’s diseaseHLA-DR3 & HLA-B8
HaemochromatosisHLA-B14
Hashimoto’s thyroiditisHLA-DR5
IDDMHLA-DR2,DR3,DR4,DQ8
Juvenile arthritisHLA-DR5
Juvenile pauciarticular arthritisHLA-DR8,HLA-DR5
Multiple SclerosisHLA-DR2
MYASTHENIA GRAVISHLA-DR3 HLA-B8
NARCOLEPSYHLA-DR2
Pemphigus vulgaris HLA-DR4 & HLA-DQ1
Perinicious anaemiaHLA-DR5
Primary biliary cirrhosisHLA-DR3
Psoriatic arthritisHLA-B27
Reactive arthritisHLA-B27
REITER’S SYNHLA-B27
Rheumatoid arthritisHLA-DR4
Sjogren’s syndromeHLA-DR3
SLEHLA-DR2 & HLA-DR3
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Appendix 128-DISEASE(GENE) - MARKER

Spondyloarthropathies

Question Answer
Ankylosing spondylitis(B*2702,-04,-05) B27
Reiter’s syndromeB27
Acute anterior uveitisB27
Reactive arthritis(yersinia,salmonella,shigella,chlmydia)B27
Psoriatic spondylitisB27
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Collagen vascular diseases

Question Answer
Juvenile pauciarticular arthritisDR8,DR5
Rheumatoid arthritis(DRB1*0401,-04,-05)DR4
Sjogren’s syndromeDR3
Systemic lupus erythematosus ,whiteDR3
Systemic lupus erythematosus,JapaneseDR2
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AUTOIMMUNE GUT AND SKIN

Question Answer
Gluten sensitivity enteropathy(COELIAC DISESASE)(DQA1*0501,DQB1*0201)DQ2
Chronic active hepatitisDR3
Dermatitis herpetiformisDR3
Psoriasis vulgarisCw6
Pemphigus vulgarisDR4 (DRB1*0402), DQ1(DQB1*0503)
Bullous Pemphigoid variantDQ7(DQB1*0301)
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AUTOIMMUNE ENDOCRINE

Question Answer
Type I diabetes mellitusDQ8,DR4,DR3,DR2
Hyperthyroidism(Graves)B8,DR3
Hyperthyroidism JapaneseB35
Adrenal insufficiencyDR3
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AUTONOMIC NEUROLOGIC

Question Answer
Myasthenia gravisB8,DR3
Multiple sclerosisDR2
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OTHERS
Question Answer
Behcet’s diseaseB51
Congenital adrenal hyperplasiaB47
NarcolepsyDR2
Goodpasture’s syndrome (anti GBM)DR2
ABACAVIR HYPERRSENSITIVITYB57
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  SLE ANTIBODIES
AntibodyClinical utility
Anti nuclear (ANA)Best SCREENING TEST (98% sensitivity);NOT Specific
Anti ds DNASLE Specific,correlate with disease activity ,Nephritis,Vasculitis
Anti Smith AbSpecific,NO clinical correlation
Anti Histone abDrug Induced Lupus
Anti Ro(SS-A) & Anti-LaPredisposes to subacute cutaneous lupus,neonatal lupus with congenital heart block ,decreased risk of nephritis
Anti Ribossomal abpsychosis due to CNS Lupus
Anti neuronal /Anti glutamate receptor correlates with CNS Lupus activity
Anti phospholipidFetal loss,clotting,Thrombocytopenia
Presence of Anti ds DNA & Anti Smith Abvirtually diagnostic of SLE (SPECIFIC)
High titres of ds DNAassociated with active renal disease
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  PATTERNS OF FLUORESCENCE IN ANTIBODIES IN SLE
Question Answer
HOMOGENOUS / DIFFUSE NUCLEAR STAININGantibodies to chromatins,histones and occasionally to ds DNA
RIM OR PERIPHERAL STAININGds DNA
Speckled pattern-most commonAb to Smith,Ribonucleoprotein , SS-A,SS-B
NUCLEOLAR PATTERNAnti to RNA,Systemic sclerosis
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Classification of CKD
STAGEGFR(ml/min/1.73m2)
0 > 90 (with risk factors of CKD)
1>= 90 (With demonstrated kidney damage –persistant proteinuria,abnormal urinary sediment ,abnormal blood and urine chemistry )
260-89
330-59
415-29
5< 15
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  URINE LAB FINDINGS IN PRERENAL ARF VS Intrinsic Renal ARF
DIAGNOSTIC INDEXPRERENAL ARFIntrinsic renal ARF
Fractional Na excretion<1>1
Urine sodium (mmol/L)<10>20
Urine creatinine:Plasma creatinine>40<20
Urine osmolality>500<300
Renal failure Index<1>1
Urine urea Nitrogen:Plasma urea Nitrogen>8<3
Urine specific gravity>1.020<1.010
Urine sedimentHyaline castMuddy brown / granular cast
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RENAL TUBULAR ACIDOSIS
LAB FINDINGType I RTA (DISTAL RTA)Type II RTA(Proximal RTA)Type IV RTA
Anion gapnormalnormalnormal
Maximum urine pH>5.5<5.5<5.5
Serum potassiumlowlowhigh
Renal stonesyesnono
Daily acid excretionlownormallow
% filtered HCO3 excreted<10>15<10
Urinary anion gappositivepositivepositive
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GAIT ABNORMALITIES
GAITDISEASE/CONDITION
Circumduction (stiff leg moves outward in circular manner )hemiparesis
Slapping / stamping gaitposterior column lesion ,subacute combined degeneration
High stepping gaitfoot drop
Rolling / waddling gaitmyopathy
Broad based gaitcerebellar (vermis) lesions,vestibular lesions
Narrow based,short strides(FESTINANT GAIT )parkinsonism
Wide based ,short strides (MARCH a petis pas,Magnetic gait )multiple small vessel cerebrovascular disease
Wide based ,irregular stridescerebellar lesions
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