DIP Episode 161 - The Clutch Auto-antibody Podcast

Okay, welcome. My name is Divine. I'm a resident. This is episode 161 of the Divine Intervention Podcast. I'm really hoping that this podcast is short, but I'm tightly in this the Clutch Auto Antibody Podcast. Basically, I just wanted to make a podcast where in one area you can essentially see like all the different high-yield Auto Antibodies that are classically tested on the USMLA exams. So what if they give you a question about a patient that you know has like morning stiffness and they'll have to like you know like workout for like an hour to get rid of that stiffness and they have like an honored deviation of their hands. What kind of Auto Antibody will be found in those people? Well, I would hope you're thinking that these people have rheumatoid arthritis right? So obviously they should have antibodies against the rheumatoid factor right? Remember rheumatoid factor is actually quite sensitive for rheumatoid arthritis and like 80% sensitive like literally like 80 per... Well, okay, yeah, it's about 80-85% but it has about 80% of people that have rheumatoid arthritis. They will have positive rheumatoid factor and they remember the anti-ccp antibodies right? You also find those in rheumatoid arthritis they are very specific for the diagnosis of a rheumatoid arthritis and then if a person has... What if they give you a question about a patient that has a Miller rush? What kind of Auto Antibody will they have?

Well, I would hope you're telling me that I would hope you're telling me that they have like any being positive right? Remember any is very sensitive for lupus about 90% of patients that have lupus who have a positive A&E but the thing is A&E is not very specific for lupus right? I mean like like think about it like if for example a person has... What is it called? A person has like mixed connectivity to disease 100% of patients with misconnectivity to disease believe it or not will have a positive A&E right? So A&E it's not very specific for not very specific for for lupus right? If you're looking in terms of specificity for lupus you want to look more to antibodies like anti-smith anti double stranded DNA stuff like that those are the ones you want to look for for the diagnosis of lupus and then what if they give you a question about a patient that is having like marital problems because she has a lot of pain with sexual intercourse and she also has dry mouth what's your diagnosis? So that's showgrain syndrome remember showgrain is associated with like anti-roantibodies so those are antibodies against SSA and then anti-land antibodies antibodies against SSA right? Those are associated with with showgrain right? I remember those are antibodies can cross the placenta and cause like a third degree or I guess you can call it a complete heart block in in the fetus right?

So that's what you want to keep at the back of your mind for tests and then although remember that you know crossing the placenta and causing third degree heart block that is not just found in that is not just found in in showgrain but you also find it in lupus like in SSA and you also find it in Lyme disease as well now what's the only pathology tested on nbim exams that's associated with C-enca so it's actually like granulomatosis with polyngitis right? So like wegners is C-enca positive what are the high old nbimipathologies as you know P-enca? Well all three of colitis believe it or not has an association with P-enca? Primary sclerosis in colangitis also has an association with P-enca polyadrys nodosa also has an association with P-enca right? Eocenophili granulomatosis with polyngitis, aka trx troughs also has an association with P-enca microscopic polyngitis also has an association with P-enca okay? So those are all things you want to keep at the back of your mind with P-enca and then what are the high old autoantibodies associated with a patient that has like proximal muscle and shoulder like weakness and then they tell you that they are creating kinase and elevated what is that? right? That's like some variant of polyobromatoma ositis right? Remember these tend to be associated with like anti-jowon antibodies right? And anti-mi 2 antibodies.

If a mom is taking anti-jowon antibodies occasionally they may not give you anti-jowon but it may ask you like oh what is like literally what is the anti-jowon antibody? Remember that it's an antibody against a trinacinthathase right? so that's a high old thing you want to keep at the back of your mind but yes polymyrositis the monomyositis has associations with anti-jowon anti-mi 2 antibodies and then there is this thing there's this autoantibody as well antibodies against like the signal recognition peptide so anti-SRP antibodies you also find those in polyodromatoma ositis and then what if they give you question about a patient that you know just been having like bleeding gums and you give your CV saying you notice everything is fine but the bleeding account is like 20,000 what's your diagnosis there? That's ITP right? That's ITP and remember that ITP right? It's where you make autoantibodies against a GP2 B3 A right? Don't confuse that with glansman from bestemia or glansman's disease where you have a deficiency of GP2 B3 and then what if they give you a question about a person that just has like autoimmune pneumolytic anemia right? Remember autoimmune pneumolytic anemia right? tends to arise in the setting of lupus right?

That's a big one you want to keep in mind and then what if they give you a question about like a 45 year old female that for the last six months she has been having jaundice she has been having right parietic episodes and they tell you that she's also been having like they show you like some labs like some LF Ts and you notice that she has a conjugated hyperbular benemia what's your diagnosis? That's primary bilaire colangitis right? And that person will have a positive AMA antibodies right? So like anti-myrochondrial antibodies and then what if a person has like a systemic sclerosis right? So like the systemic scleroderma what is the autoantibody that's associated with that? Well that's your anti-SEL 70 antibody right? Sometimes it's called the anti-atopoeist summaries antibody and then so anti-atopoeist summaries one contrast this with like the limited scleroderma right?

So like the crest of scleroderma where people have the pentad of like a caucinosis, renal phenominone, it's a geodesmoltivity so they can have like really bad really bad bird and then they'll have like sclerodactylene so like weirdness of their fingers and then they will have telangetic tissues on the skin crest scleroderma right also called limit-theft scleroderma is associated with anti-centromere antibodies so that's a big one you want to keep at the back of your mind and then what if they give you a question about a patient that was recently studied on treatment for TB and this patient has a Miller-Rash what's your diagnosis? That's drug-induced lupus right? I remember drug-induced lupus is associated with anti-histone antibodies and remember your drugs that can cause drug-induced lupus right? So like yourself phonomites, hydrozene, isoniazid, proquinomite, etanersept, those are always associated with drug-induced lupus so they can very easily write a question about a patient that has WPW syndrome that is well controlled that has like a Miller-Rash where they'll be pretty classic drug-induced lupus so just something to keep at the back of your mind or a patient that was recently again studied on treatment for TB that has a whatever so just again drug-induced lupus anti-histone antibodies and then if a person has mixed connective tissue disease what auto-antibody are you thinking about?

Well I would really hope you're thinking about antibodies against the U1 ribonucleoprotein right? So anti-U1 RMP antibodies have a pretty strong association with a pretty strong association with a mixed connective tissue disease and then what is the auto-antibody that is associated with post-infectious glomerulonophyrides? Well I would hope that your telling me that it's like you know ASO right? So like anti-striptolizing O antibodies and also antibodies against DNA's B so anti-DNA's B and T bodies remember those are very specific for like a strep skin infection right? That's the ultimate etiology of a person having a post-infectious sublomerulonophyrides. Now what if they give you a question about a patient that is like 17 years old and has diabetes right? Like you know thin what has diabetes right? You're probably thinking about like type 1 diabetes. The auto-antibodies you want to remember there right then like the big ones you want to remember like auto-antibodies against like like essentially like anti-i-let cell antibodies but there are some specific ones like the most common one is like anti-gad antibodies so anti glutamate decarboxylase antibodies and also there's also antibodies against I-8-2 right? So those are the big higher antibodies you want to keep at the back of your mind with type 1 diabetes and then if a person has you know like hypothyroidism what is the most common cause of hypothyroidism in the US? Well I hope you're telling me Hashimoto's right?

Remember Hashimoto's has associations with the auto-antibodies you'll find in Hashimoto's right? Like auto-antibodies against like auto-antibodies against like anti-thyro peroxidys antibodies, anti-fire globalin antibodies right? And then the close cause of Hashimoto's right? I guess maybe you can think of it as a person that's hyperthyroid right? Think about Greer's disease, remember Greer's disease classically has associations with thyroid stimulating in new globalin right? So you make like stimulating antibodies against the TSA receptor and then if a person has you know like you know the tell you that like 45-year-old female, trouble swallowing, droopy eyes and she notices that eyes get more droopy by the end of the day right? That's classic myostenia gravis remember those people make auto-antibodies against the nicotinic acetylcholine receptor right? So that's a big one you want to keep at the back of your mind and then remember that if you form anti-arachantibodies right? That's associated with um hemolytic disease of the newborn right? But occasionally your friends at the NBME right? They write these questions with a president hemolytic disease of the newborn but it arises from like other other kinds of antibodies the most popular one on NBME is at the anti-cal K-E-double L antibodies.

So that's when you'd want to you know come into memory for exams and then what if they give you a question about a patient that you know has like a really bad encephalitis and they tell you that oh they recently had like um I don't know like some kind of viral upper respiratory infection or they recently got like uh like a viral style vaccine or they recently had like a visi-v outbreak.

I'm off hope on those circumstances you're thinking about like autoimmune encephalitis um that tends to be associated with antibodies against the NMD receptor that's a pretty classic again you may say divine some of these antibodies you have mentioned you have never heard of them before um I promise you may not have heard of them before but you may hear of them of the first for the first time when you examine it's just one of those high-yield things to I promise you there I know I'm going over these antibodies so definitely keep those in mind and then if they give you a question about a patient patient that has like a histro-like breast cancer and in this person has like a profound etaxia and all that stuff right uh that's something called like a limbic encephalitis and it's very high you to non-nBME exams that that is associated with antibodies against you and you so H-U so anti-h-U and Y-O anti-U antibodies okay and then one of the thing your friends are the MBME love to test is like autoimmune hepatitis right so autoimmune hepatitis very high you to know about um basically there are two types right there's like a type 1 autoimmune hepatitis and there's a type 2 autoimmune hepatitis and um the type 1 is associated with anti-smoke muscle antibodies right that's when you definitely want to know and then the type 2 is associated with anti-liber kidney microthermal antibodies typically you'll see autoimmune hepatitis in the setting of like uh like a lupus-like syndrome in fact some people call it like a lupoid hepatitis okay so those are big picture things you want to keep at the back of your mind and then if for example a person has you know they tell you that the person like you get an example question and this person seems to you know they keep having like this uh painful vision loss that then gets better after a few weeks when they get high high low scotico steroids

and then they have like these recurring episodes where they have like sensory level right uh where like oh they lose all sensation below the nipples right so like t4 I remember there's an amonic for that like t4 tit like tit like tit 4 and then the lose sensation below like t10 or whatever blah blah blah blah whenever you see all those things um like recurring episodes of like optic neuritis and recurring like my lytic out hope under those circumstances you're thinking about like it's almost like an MS variant it's known as um um neuromyelitis optica okay neuromyelitis optica sometimes people call it a devex DEVIC devex disease okay so remember that those are associated with like antibodies against uh uh an MO so anti-an MO IgG antibodies uh think about those as being associated with neuromyelitis neuromyelitis optica and then I remember right antifusualypeed antibodies right so like recurring pregnancy losses in a person that may have like a histral lupus uh classically these things tend to shop on uh inbene exams in a woman that's pregnant and she has like size uh less than beats so they'll tell you that oh she's at like 30 weeks gestition but then you measure from like the fundus to the pubic synthesis and it's like 22 centimeters right that size less than beats that's pretty classic for um for antifusualypeed antibodies syndrome and then what if you get a question about a patient that has um uh uh let's see I think I've already talked sorry I'm giving this uh mostly from memory um I think I've talked about like uh yeah I think I've talked about it already where they give you like some fancy pants question about a person that has a history of um um has a history of um like you know for this something your female with like John base and providers yeah that's um primary blyric lanjitis has an association with that anti-moutocultural antibodies now what if they give you

a question about a patient that has like hematuria and has like hemoptysis what kind of auto antibodies are associated with those well I hope you're telling me like antibodies against the glomerular basement memory right antibodies against the glomerular bristin membrane that is uh that is a pretty classic for um uh that is pretty classic for for uh the good pastures syndrome right good pastures syndrome you make auto antibodies against the basement membrane and then um what if you make antibodies against the desmosomes what skin the solder is that associated with well I hope you're telling me our pemp figures vulgaris right you make antibodies against desmosomes so like anti like desmoglian or anti desmoplicin antibodies uh those are pretty classic for um for um um come on divine think uh antibodies against that's classic for our pemp figures vulgaris then contrast that with its close cousin right like boulos pemp figoid boulos pemp figoid right those people tend to form antibodies against like hemidesmosomes right that's a big one you want to remember antibodies against hemidesmosomes remember boulos pemp figoid is not as dangerous as pemp figures vulgaris and boulos pemp figoid is not um is not um nickel ski positive okay these are all high-eal things you want to keep in mind for exams and then what if they give you a question about a patient that you know has like Fatmal absorption like low weight um and then they tell you that the person has like a rash on extensive surfaces of the upper and lower extremities um that it does not have a silver scale right i'll hope on that those circumstances you're thinking about ciliac disease remember ciliac disease has an association with anti gliadin antibodies and also has associations with like anti um tissue transglutaminis and anti endomysial so e-n-d-o-m-y-s-i-a-l so anti endomysial antibodies and then um um um what if

they give you a question about a patient that has um you know like you've smoked for like a long time and then they've been having trouble like rising from a chair what are you thinking about right that's lumbarity my stank syndrome right remember in lumbarity tin those people make auto antipodes against like the presynaptic avotage-gated calcium channel right so that's a big one you want to keep at the back of your mind and then what if they give you a question about a patient that has um um let's see they give you a question about a patient that you know you know has been uh has lost like uh uh like vibratory sensation in the lower extremities and this patient also has like uh you know like some babinski things going on so like opera like like some opal moron neuron problems from like the corticospinal tract being knocked out and um like some dorsal column problems I would hope on that those circumstances you're really thinking about like a bit of deficiency right remember bit of deficiency because by uh uh pernisios anemia right and in pernisios anemia you make antibodies against like intrinsic factor or antibodies against the parietal cells right so those are all big things when you keep at the back of your mind for tests now what if they give you a question about um I think I already talked about antifosculipid antipodes syndrome right remember these people tend to make like lupus anticoagulant anticarduolipin antibodies right so those are again all big things you want to keep keep at the back of your mind for exams and other like weird one you may see on nbm is uh a person having like antibodies against like bitter to glycoprotein uh that's actually pretty classic for for antifosculipid antibody syndrome as well again these are all things they love to test I'm just trying to think is they know the higher thing I've not really mentioned um yes so the HL Es right s

o there are some HL Es that are very high you know I think I'm probably going to like spend time on like three of them that they love to test for whatever reason on nbm exams remember your certain negatives of spondyloa thropathies right those tend to be associated with um those tend to be associated with um HLE B27 right and then what if they give you a question about a patient that you know was recently studied on a drug for HIV this patient takes this drug for HIV and then not longer afterwards they get like a profound and a phylactic reaction and die right what kind of drug are you thinking about well I hope you're thinking about um I really hope you're thinking about abacavir abacavir is a HIV drug you need to check for HLE B57 before you start abacavir right because it has uh about eight percent of people that take abacavir can get a life threatening a high percentage of the reaction so you want to make sure that you go ahead and check uh auto antibuses against the like the I mean not auto antibuses but you check for the HLE B57 of genotype and then um what if they give you a question about a patient from Iran that has like you know like the person speaks for us or whatever that has uh you know like painful stores on the in the Bocomucosa what is that that's beshets disease right that's beshets disease remember that beshets disease has an association with like HLE um HLE B51 right and remember that the diagnostic test because I don't know why people keep getting this wrong we have to your name be an exam but the diagnostic test for beshets disease right is the pathogen test like PATH I mean you can do like biopsy or whatever but there's this test known as the pathogen test it's like you prick you do like a certain prick like a specific like length or whatever bloody bloody blood you can read up on it what PATH ARGY pathogen test it's used to like screen or diagno

sis um beshets disease right so that's a high-yield one you want to keep on the back of your mind and what if they give you a question about um uh trying to think is any other antibody I've not talked about like I've talked about most of the high-yield or at least the ones that are coming to mind um yeah I think I'm going to go ahead and stop here um and as I do at the end of every podcast where they do offer uh actually but before I see that so please actively like pay attention to this podcast this is one of those podcasts where you know maybe you're writing the information out unless going over it a couple of times or doing flashcards probably not the worst idea in the world because if you're taking an U.S.

similarly exam and you don't get an auto antibody question uh you probably like something has probably gone horribly on that test they love to test auto antibodies all the time right so you should probably you know make sure you understand uh no distance right I know it's a lot I mean I didn't want to imagine that you know my thinking was oh this podcast will be like five or ten minutes but I'll imagine all the antibodies we've talked about so I definitely know these things if I were you um you're definitely going to see it on your exam um so um as I do at the end of every podcast I don't for tutoring for pretty much any exam you can take as a medical person right so like step well well I guess not every example like step one step two CK step two C.S.

step three if you're medicine resident like the medicine in training exam or the iBA I'm born exam or if you need tutoring for like your pre clinical uh uh blocks in as a M1 M2 med student or your third year of exams also also uh offer tutoring for all those things and then um this longitudinal tutoring that I offer right where uh if you're a first second or third year med student I teach you for like your block exams or for your shelf exams but at the same time I teach you for your upcoming USMLE exam everyone I've done that with I've been very very successful because it's like you're learning the material for your block exams we are learning USMLE relevant material at the same time and test-taking strategy right so that again has been very successful with people so that's something interested in free free to reach out to me and then the last thing I offer is uh these uh uh this USMLE booster courses where if you're you know studying for like step two CK step three that's a 10 hour course or step one that's a 20 hour course where in that time frame I review all the like most of the high-year content that you likely see on your exam in a very short time frame it's ideal for someone that as you know completed like a pass through the material and feels good about the knowledge base or a person that um is like in the last week of the dedicated period and they want someone to put everything together for them you know like uh one on one on one basis I just reach out to me I can point you in the right direction with those and I guess if you have any college body that needs to learn from like Gen Chem, O Chem, Physics, Bio Chem, Histology, Physiology, Alpha Therum for all those things and then um if you need like coaching or like advising or like consulting for like uh eras applications so that's like a medicine point residency or I'm cas applications if you're a college stude

nt applying to med school I do offer those as well so you can either reach out to me through the website or you can send me an email at divine intervention podcasts with an sadeandaginno.com so have a wonderful rest of your day thank you for listening to this podcast I hope to make more in the in the in the near future thank you and God bless you bye

Anti-CCP antibodies.

Anti-Ro/SSA and Anti-La/SSB antibodies.

Anti-Synthetase Syndrome (often includes ILD and "mechanic's hands").

Antibodies against U1 RNP.

Anti-gliadin and anti-endomysial antibodies.

Anti-Mitochondrial Antibodies (AMA).

Positive lupus anticoagulant, anti-cardiolipin antibodies, and anti-$\beta_2$ glycoprotein I.

Anti-centromere antibodies.

Anti-smooth muscle antibodies and anti-microsomal antibodies.

Antibodies against the nicotinic acetylcholine receptor (A ChR).

Anti-thyroperoxidase antibodies (Anti-TPO) and anti-thyroglobulin antibodies.

p-ANCA (perinuclear anti-neutrophil cytoplasmic antibody).

Anti-LBM antibodies and anti-snai antibodies.

Positive lupus anticoagulant, anti-cardiolipin antibodies, and anti-$\beta_2$ glycoprotein I.

Anti-centromere antibodies.

Anti-smooth muscle antibodies and anti-microsomal antibodies.

Antibodies against the nicotinic acetylcholine receptor (A ChR).

Anti-thyroperoxidase antibodies (Anti-TPO) and anti-thyroglobulin antibodies.

p-ANCA (perinuclear anti-neutrophil cytoplasmic antibody).

Anti-LBM antibodies and anti-snai antibodies.