Rheumatology and Immunology Practice Questions

Q: Renal involvement is usually absent in which of the following conditions?

Drug-induced systemic lupus erythematosus (SLE). **Explanation:** The correct answer is **Drug-induced systemic lupus erythematosus (SLE)**. **1. Why Drug-induced SLE is the correct answer:** Drug-induced SLE (DILE) is a syndrome that shares clinical features with idiopathic SLE but is triggered by specific medications (e.g., Hydralazine, Procainamide, Isoniazid). A hallmark of DILE is its **mild clinical course**. Unlike idiopathic SLE, DILE characteristically **spares the kidneys and the Central Nervous System (CNS)**. It typically presents with constitutional symptoms, arthralgia, and serositis. Laboratory findings show **Anti-histone antibodies** in >95% of cases, while Anti-dsDNA and low complement levels (C3, C4) are rare [1]. **2. Why the other options are incorrect:** * **Adult SLE:** Renal involvement (Lupus Nephritis) occurs in approximately 40–50% of adult patients and is a major cause of morbidity and mortality [1]. * **Pediatric SLE:** Childhood-onset SLE tends to be **more aggressive** than adult-onset disease. Renal involvement is more frequent (up to 80%) [2] and often more severe at presentation. * **SLE during Pregnancy:** Pregnancy can trigger flares of SLE. Lupus nephritis is a significant concern during pregnancy as it mimics pre-eclampsia and increases the risk of adverse maternal and fetal outcomes. **3. High-Yield Clinical Pearls for NEET-PG:** * **Most common drug causing DILE:** Procainamide (highest risk), but Hydralazine is more commonly used clinically. * **Genetic Predisposition:** "Slow acetylators" are at a higher risk of developing DILE. * **Key Lab Marker:** Anti-histone antibodies (High sensitivity for DILE) [3]. * **Management:** Symptoms usually resolve within weeks of discontinuing the offending drug. * **Mnemonic for DILE drugs (HIP):** **H**ydralazine, **I**soniazid, **P**rocainamide (also Phenytoin, Penicillamine).

Q: Aortic arch syndrome is also known as:

Takayasu's arteritis. **Explanation:** **Takayasu’s Arteritis (Option A)** is the correct answer. It is a chronic, systemic inflammatory large-vessel vasculitis that primarily affects the **aorta and its major branches** [1]. The inflammation leads to stenosis, occlusion, or aneurysmal dilation of the vessels. Because it frequently involves the aortic arch and its branches (brachiocephalic, carotid, and subclavian arteries), it results in diminished or absent pulses in the upper extremities, earning it the clinical name **"Aortic Arch Syndrome"** or **"Pulseless Disease."** **Why the other options are incorrect:** * **Kawasaki Disease (Option B):** A medium-vessel vasculitis primarily affecting children [2]. Its most dreaded complication is **coronary artery aneurysms**, not aortic arch syndrome [2]. * **Churg-Strauss Syndrome (Option C):** Now known as Eosinophilic Granulomatosis with Polyangiitis (EGPA), this is a small-vessel vasculitis characterized by asthma, eosinophilia, and necrotizing vasculitis. * **Giant Cell Arteritis (Option D):** While also a large-vessel vasculitis, it typically involves the **extracranial branches of the carotid artery** (e.g., temporal artery) in patients over 50. While it can involve the aorta, it is not synonymous with Aortic Arch Syndrome. **High-Yield Clinical Pearls for NEET-PG:** * **Demographics:** Most common in young females ( 10 mmHg difference between arms), and bruits over the subclavian or aorta. * **Diagnosis:** Gold standard is **CT/MR Angiography** showing "skip lesions" or wall thickening. * **Histopathology:** Granulomatous inflammation of the adventitia and media [1].

Q: Which of the following conditions typically spares the joints of the hand?

Ankylosing Spondylitis. ### Explanation **1. Why Ankylosing Spondylitis (AS) is the Correct Answer:** Ankylosing Spondylitis is the prototype of **Seronegative Spondyloarthritides (SpA)**. Its hallmark is involvement of the **axial skeleton**, specifically the sacroiliacy joints (sacroiliitis) and the spine [1]. While AS can involve peripheral joints, it typically affects **large proximal joints** (like the hips and shoulders) in an asymmetrical fashion. It characteristically **spares the small joints of the hands**. If a patient with SpA presents with hand involvement, clinicians should look toward Psoriatic Arthritis or Reactive Arthritis instead. **2. Why the Other Options are Incorrect:** * **Rheumatoid Arthritis (RA):** Classically involves the small joints of the hand, specifically the **MCP and PIP joints**, in a symmetrical pattern [3]. It characteristically spares the DIP joints. * **Osteoarthritis (OA):** Frequently involves the hands, specifically the **DIP joints (Heberden’s nodes)** and **PIP joints (Bouchard’s nodes)**, as well as the first carpometacarpal (CMC) joint [3]. * **Psoriatic Arthritis (PsA):** A Seronegative SpA that, unlike AS, frequently involves the hands. It is known for **DIP joint involvement**, "pencil-in-cup" deformities, and dactylitis ("sausage digits") [2]. **3. NEET-PG High-Yield Pearls:** * **DIP Involvement:** Seen in Psoriatic Arthritis and Osteoarthritis; **spared** in Rheumatoid Arthritis. * **MCP/PIP Involvement:** Classic for Rheumatoid Arthritis. * **HLA-B27:** Strongly associated with AS (>90% of cases) [1]. * **Bamboo Spine:** The classic radiographic finding in late-stage AS due to marginal syndesmophytes and fusion of vertebrae [1]. * **Extra-articular manifestation of AS:** The most common is **Acute Anterior Uveitis** (unilateral) [1].

Q: Which of the following conditions is associated with anti-proteinase-3 positivity?

Wegener's granulomatosis. The correct answer is **Wegener’s Granulomatosis** (now officially known as Granulomatosis with Polyangiitis or GPA). **1. Why Wegener’s Granulomatosis is correct:** GPA is a small-vessel vasculitis characterized by the triad of upper respiratory tract involvement, lower respiratory tract involvement, and glomerulonephritis [2]. The hallmark serological marker for GPA is **c-ANCA** (cytoplasmic Antineutrophil Cytoplasmic Antibody), which shows a diffuse cytoplasmic staining pattern on immunofluorescence. The primary target antigen for c-ANCA is **Proteinase-3 (PR3)**. Approximately 90% of patients with active, systemic GPA are positive for anti-PR3 antibodies. **2. Why the other options are incorrect:** * **Churg-Strauss Syndrome (EGPA):** This is primarily associated with **p-ANCA** (perinuclear pattern), where the target antigen is **Myeloperoxidase (MPO)** [1]. It is clinically distinguished by asthma and peripheral eosinophilia [1], [2]. * **Microscopic Polyangiitis (MPA):** While MPA is also a small-vessel vasculitis, it is most strongly associated with **p-ANCA (anti-MPO)** rather than anti-PR3. Unlike GPA, it lacks granulomatous inflammation [2]. * **Polyarteritis Nodosa (PAN):** PAN is a medium-vessel vasculitis that is characteristically **ANCA-negative**. It is frequently associated with Hepatitis B infection and involves "rosary sign" microaneurysms on angiography [2]. **High-Yield Clinical Pearls for NEET-PG:** * **c-ANCA = Anti-PR3** (Associated with GPA/Wegener’s). * **p-ANCA = Anti-MPO** (Associated with MPA, EGPA, and Primary Sclerosing Cholangitis). * **GPA Triad:** Sinusitis (saddle nose deformity), Lung nodules/hemoptysis, and Crescentic Glomerulonephritis [2]. * **Drug-induced ANCA:** Propylthiouracil (PTU), Hydralazine, and Methimazole can cause p-ANCA positivity.

Q: All of the following are true about Temporal Arteritis except?

Low ESR. Temporal Arteritis, also known as **Giant Cell Arteritis (GCA)**, is a large-vessel vasculitis that primarily affects the extracranial branches of the carotid artery [1]. **Why "Low ESR" is the correct answer:** In GCA, the Erythrocyte Sedimentation Rate (ESR) is characteristically **markedly elevated**, often exceeding **100 mm/hr**. A low or normal ESR is extremely rare in active disease and is used as a negative predictive factor [1]. C-reactive protein (CRP) is also typically elevated. **Analysis of other options:** * **Polymyalgia Rheumatica (PMR):** Approximately 40–50% of patients with GCA also have PMR, characterized by proximal muscle pain and stiffness (shoulders and hips) [1]. * **Anemia:** Chronic inflammation in GCA leads to **Anemia of Chronic Disease** (normocytic, normochromic), which is a common systemic finding. * **Sudden Blindness:** This is the most feared complication. It occurs due to **Anterior Ischemic Optic Neuropathy (AION)** caused by occlusion of the posterior ciliary arteries [1]. It is a medical emergency requiring immediate high-dose steroids. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard Diagnosis:** Temporal artery biopsy (look for "skip lesions"; hence, a long segment must be biopsied) [1]. * **Histopathology:** Granulomatous inflammation with multinucleated giant cells and fragmentation of the internal elastic lamina [1]. * **Treatment:** Do not wait for biopsy results; start **High-dose Glucocorticoids** immediately if GCA is suspected to prevent permanent vision loss [1]. * **Demographics:** Almost exclusively occurs in patients **>50 years** of age.

Question 1

Renal involvement is usually absent in which of the following conditions?

Accepted Answer

Drug-induced systemic lupus erythematosus (SLE)

Answer

Adult SLE

Answer

Pediatric SLE

Answer

SLE during pregnancy

Question 2

A 63-year-old man presents to the emergency room with severe pain and swelling in his right knee. The pain started suddenly, and there is no history of injury to the knee. On physical examination, the knee is warm, red, and swollen with decreased range of movement. A diagnostic aspiration of the knee is performed. Which of the following findings will most likely distinguish pseudogout from gout?

Accepted Answer

Needle-shaped, negatively birefringent crystals on polarized microscopy

Answer

Needle-shaped, positively birefringent crystals on polarized microscopy

Answer

Rhomboid-shaped, negatively birefringent crystals on polarized microscopy

Answer

Rhomboid-shaped, positively birefringent crystals on polarized microscopy

Question 3

Which metacarpophalangeal (MC) joint is commonly involved in gout?

Accepted Answer

Metacarpophalangeal joint of the big toe

Answer

Knee

Answer

Hip

Answer

Metacarpophalangeal joint of the thumb

Question 4

Aortic arch syndrome is also known as:

Accepted Answer

Takayasu's arteritis

Answer

Kawasaki disease

Answer

Churg-Strauss syndrome

Answer

Giant cell arteritis

Question 5

Which of the following conditions typically spares the joints of the hand?

Accepted Answer

Ankylosing Spondylitis

Answer

Rheumatoid Arthritis

Answer

Osteoarthritis

Answer

Psoriatic Arthritis

Question 6

Bridge therapy is employed in which of the following conditions?

Accepted Answer

Rheumatoid arthritis

Answer

Mononeuritis multiplex

Answer

Osteoarthritis

Answer

Caplan syndrome

Question 7

Which of the following conditions is associated with anti-proteinase-3 positivity?

Accepted Answer

Wegener's granulomatosis

Answer

Churg Strauss syndrome

Answer

Microscopic polyangiitis

Answer

Polyarteritis nodosa

Question 8

All of the following are true about Temporal Arteritis except?

Accepted Answer

Low ESR

Answer

Polymyalgia Rheumatica

Answer

Anemia

Answer

Sudden blindness

Question 9

A 27-year-old male presents with burning micturition and urethral discharge. After 4 weeks, he develops joint pains involving both knees and ankles, redness of the eyes, and skin lesions. What is the most probable clinical diagnosis?

Accepted Answer

Reiter's syndrome

Answer

Psoriasis vulgaris

Answer

Behcet's syndrome

Answer

Sarcoidosis

Question 10

Which of the following statements is not true about Gout?

Accepted Answer

Aspiration shows urate crystals which are needle-shaped and positively birefringent.

Answer

Alcohol is a risk factor for the disease.

Answer

Tophi are characteristic of gout.

Answer

The great toe is most commonly affected.

Rheumatology and Immunology — MCQs

Rheumatology and Immunology — MCQs

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