Antiphospholipid Antibody Syndrome MCQs

C.trachomatis caused ~30-40% of cases of non- gonococcal urethritis (NGU). M. genitalium - probable cause of many Chlamydia-negative cases. U. urealyticum but not U. parvum is associated with NGU. Reference: Harrison's Principles of Internal Medicine, 21 st ed, Ch: 136, Pg: 1080

Answer is 'b' i.e. Negligible size of emboli

Primary biliary cirrhosis is more common in females and is usually associated with raised IgM levels. Xanthelasma are present due to cholestasis. Connective tissue disorders such as Sjogren's syndrome are associated. A positive antimitochondrial antibody and liver biopsy are the best ways to confirm the diagnosis. Reference : Harrison's Principles of Internal Medicine , 21 st Ed, Ch: 344 Pg: 2627

Clinical criteria include vascular thrombosis, defined as one or more clinical episodes of arterial, venous, or small vessel thrombosis in any tissue or organ; and pregnancy morbidity, defined as one or more unexplained deaths of a morphologically normal fetus at or beyond the 10th week of gestation; one or more premature births of a morphologically normal neonate before the 34th week of gestation because of eclampsia, severe preeclampsia, or placental insufficiency; or three or more unexplained consecutive spontaneous abortions before the 10th week of gestation. Laboratory criteria include LA, anticardiolipin (aCL), and/or anti-β2 GPI antibodies, at intermediate or high titres on two occasions 12 weeks apart. Reference: HARRISON'S PRINCIPLES OF INTERNAL MEDICIENE, ED 21 st , CHAPTER 357 pg 2749

Answer is B (Sterility): Systemic Lupus Erythematosus. Recurrent Abortions in SLE may be seen as a manifestation of Antiphospholipid Antibody syndrome. Small proportion of patients with SLE may have a Coomb's Positive Haemolytic anemia. Psychosis is a known neurological manifestation of SLE.

Anti-GAD has highest persistence rate in Type 1 DM after initial diagnosis Anti GAD is also the most common antibody identified in subjects with Type 1 DM Anti insulin antibody is the earliest appearing antibody in Type 1 DM and has the highest risk of progression to overt DM Reference: ISPAD Guidelines on Pediatric and Adolescent Diabetes - 2022

The treatment of choice is immunosuppression with horse ATG, which is safer than currently available rabbit ATG. Horse ATG should be followed by ciclosporin as longer-term immunosuppression. It induces hematologic recovery (independence from transfusion and a leukocyte count adequate to prevent infection) in 60-70% of patients. Allogeneic stem cell transplantation is reserved as first -line treatment for young patients ( Supportive care is important but not as sole therapy and there is no proven useful role for G-CSF. Long-term glucocorticoids dramatically increase the risk of fatal fungal infection in neutropenic patients. Reference: Harrison's Principles of internal med 21st ed chap 102, pg. 797

Environmental exposure to myelosuppressive chemicals and radiation are now uncommon causes of aplastic anemia. Fanconi anemia and dyskeratosis congenita (disorders of DNA repair and telomere maintenance, respectively, account for no more than 20% of cases). The majority of patients with acquired aplastic anemia have an autoimmune disease characterized by oligoclonal T-cell populations that function to repress stem cell function. This accounts for the favorable responses to immunosuppressive therapy in such patients. Reference: Harrison's Principles of internal medicine 21st ed chap 116 pg. 911