Rheumatology and Immunology Practice Questions

Q: Deforming polyarthritis is associated with all of the following except?

Behcet's syndrome. The core concept behind this question is distinguishing between **erosive/deforming** arthritides and **non-erosive/non-deforming** arthritides. **Why Behcet’s Syndrome is the Correct Answer:** Behcet’s syndrome is a multisystem inflammatory vasculitis. While joint involvement is common (occurring in about 50% of patients), it typically presents as a **non-erosive, non-deforming, self-limiting peripheral arthritis** or arthralgia. It most frequently affects the knees and ankles. Unlike the other options, it does not lead to permanent joint destruction or deformity. **Analysis of Incorrect Options:** * **Rheumatoid Arthritis (RA):** The hallmark of RA is symmetric, inflammatory, **erosive polyarthritis**. Chronic synovial inflammation leads to joint space narrowing and bone erosions, resulting in classic deformities like ulnar deviation, Swan-neck, and Boutonniere deformities [2]. * **Psoriatic Arthritis (PsA):** This is a seronegative spondyloarthropathy that can be highly destructive. The "Mutilans" subtype is specifically known for severe joint lysis and "pencil-in-cup" deformities, leading to significant digital shortening and deformity [1]. * **Ankylosing Spondylitis (AS):** While primarily affecting the axial skeleton, AS can involve peripheral joints (especially the hips and shoulders). The disease process involves both erosion and syndesmophyte formation (new bone), leading to **ankylosis** (fusion) and permanent postural deformities (e.g., "Bamboo spine") [3]. **NEET-PG High-Yield Pearls:** * **Behcet’s Triad:** Recurrent oral ulcers, genital ulcers, and uveitis. * **Pathergy Test:** A highly specific diagnostic test for Behcet’s (skin hyperreactivity to a needle prick). * **Jaccoud’s Arthropathy:** A classic "deforming but non-erosive" arthritis seen in **SLE**, where deformities are due to ligamentous laxity rather than bone destruction. * **HLA-B51:** Strongly associated with Behcet’s syndrome.

Q: True regarding Sjogren's syndrome are all of the following except?

Males are commonly affected. **Explanation:** Sjögren’s Syndrome (SS) is a chronic, systemic autoimmune disorder characterized by lymphocytic infiltration of the exocrine glands, primarily the lacrimal and salivary glands [2]. **1. Why Option B is the Correct Answer (The Exception):** Sjögren’s syndrome has one of the most striking gender predilections among all autoimmune diseases. It predominantly affects **females**, with a female-to-male ratio of approximately **9:1**. Therefore, the statement that "males are commonly affected" is incorrect. It typically presents in the 4th to 6th decades of life. **2. Analysis of Other Options:** * **Option A (Autoimmune condition):** This is true [1]. It involves B-cell hyperactivity and T-cell mediated destruction of exocrine tissue. It can occur alone (Primary SS) or in association with other autoimmune diseases like Rheumatoid Arthritis or SLE (Secondary SS) [2]. * **Option C (Progressive destruction):** This is true. The hallmark is the progressive destruction of glands leading to **Sicca symptoms**: Xerophthalmia (dry eyes) and Xerostomia (dry mouth). * **Option D (No single pathognomonic test):** This is true. Diagnosis relies on a combination of clinical symptoms, objective tests for ocular/oral dryness (Schirmer’s test), serology (Anti-Ro/SSA, Anti-La/SSB), and histopathology (minor salivary gland biopsy showing a focus score ≥1) [2]. **Clinical Pearls for NEET-PG:** * **Most common associated malignancy:** Non-Hodgkin Lymphoma (MALToma) – patients have a 40x higher risk. * **Extraglandular manifestations:** Raynaud’s phenomenon, cutaneous vasculitis, and interstitial nephritis. * **Serology:** Anti-Ro (SS-A) and Anti-La (SS-B) are characteristic but not 100% specific [2]. * **Gold Standard Diagnosis:** Minor salivary gland biopsy (Lip biopsy).

Q: Churg-Strauss syndrome is characterized by all the following features EXCEPT:

Large-vessel vasculitis. **Explanation:** **Churg-Strauss Syndrome (CSS)**, now officially known as **Eosinophilic Granulomatosis with Polyangiitis (EGPA)**, is a systemic necrotizing vasculitis [1], [3]. 1. **Why Option B is the Correct Answer:** EGPA is classified as a **small-vessel vasculitis** [1]. It primarily affects small to medium-sized arteries, capillaries, venules, and arterioles. It is grouped under **ANCA-associated vasculitides** (along with Granulomatosis with polyangiitis and Microscopic polyangiitis). It does *not* involve large vessels like the aorta or its major branches (which is characteristic of Takayasu arteritis or Giant Cell Arteritis) [2]. 2. **Analysis of Other Options:** * **Option A (Allergic rhinitis):** This is a hallmark feature. EGPA typically progresses through three phases: the prodromal phase (asthma and allergic rhinitis), the eosinophilic phase (peripheral blood eosinophilia), and the final vasculitic phase [3]. * **Option C (Eosinophilic vasculitis):** The presence of tissue infiltration by eosinophils and extravascular granulomas is a pathognomonic histological finding of this condition [1]. * **Option D (Treatment):** Systemic corticosteroids are the mainstay of therapy [1]. In severe or multi-organ cases, immunosuppressants like Cyclophosphamide or Rituximab are added to induce remission [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Classic Triad:** Asthma, peripheral eosinophilia (>1500 cells/µL), and systemic vasculitis [1], [3]. * **ANCA Status:** p-ANCA (anti-MPO) is positive in approximately 40-50% of cases (more common when there is renal involvement) [1]. * **Most common organ involved:** The Lung (Asthma is the most common presenting feature) [3]. * **Cardiac Involvement:** This is the leading cause of mortality in EGPA (e.g., eosinophilic myocarditis).

Q: What is true about Henoch-Schonlein purpura?

IgA deposition in mesangium. **Henoch-Schönlein Purpura (HSP)**, now commonly referred to as **IgA Vasculitis**, is the most common systemic vasculitis in children. It is characterized by the deposition of immune complexes containing **Immunoglobulin A (IgA)** in the walls of small vessels [1]. ### **Explanation of Options** * **Correct Answer (C):** The hallmark of HSP is the deposition of **IgA-dominant immune complexes** in the mesangium of the kidneys (similar to IgA Nephropathy/Berger’s disease) and in the walls of small blood vessels in the skin and GI tract [1], [2]. This triggers an inflammatory response leading to the clinical manifestations. * **Option A:** HSP is a **small-vessel vasculitis**, not a medium-vessel vasculitis (like Polyarteritis Nodosa or Kawasaki disease) [1]. It primarily affects arterioles, capillaries, and venules. * **Option B:** While skin rashes are often the presenting sign, renal involvement (HSP nephritis) typically occurs **early**, usually within 4–6 weeks of the initial presentation [2]. Monitoring for hematuria and proteinuria is critical during the acute phase. * **Option D:** HSP is a **non-thrombocytopenic purpura**. The platelet count is characteristically **normal or high** (inflammatory marker). The purpura is "palpable" because it is caused by vessel wall inflammation (vasculitis), not a deficiency in platelets. ### **High-Yield Clinical Pearls for NEET-PG** * **Classic Tetrad:** 1. Palpable purpura (without thrombocytopenia), 2. Arthralgia/Arthritis, 3. Abdominal pain (may lead to intussusception), 4. Renal disease. * **Trigger:** Often follows an **Upper Respiratory Tract Infection (URTI)** [1], [2]. * **Diagnosis:** Primarily clinical; skin biopsy shows **leukocytoclastic vasculitis** with IgA deposits on immunofluorescence. * **Prognosis:** Generally excellent and self-limiting; the long-term prognosis depends entirely on the severity of **renal involvement** [2].

Q: What is the investigation of choice for the diagnosis of Giant Cell Arteritis?

Temporal artery biopsy. **Explanation:** **Giant Cell Arteritis (GCA)**, also known as temporal arteritis, is a large-vessel vasculitis that primarily affects the extracranial branches of the carotid artery in patients over 50. 1. **Why Temporal Artery Biopsy (TAB) is the Correct Answer:** TAB remains the **Gold Standard** and investigation of choice for definitive diagnosis [1]. Histopathology typically reveals panarteritis with mononuclear cell infiltration and, in 50% of cases, multinucleated giant cells. Because GCA is a "segmental" disease (skip lesions), a long segment of the artery (3–5 cm) must be biopsied to avoid false negatives [1]. 2. **Why Other Options are Incorrect:** * **Colour Doppler (Option B):** While it may show the characteristic **"Halo sign"** (vessel wall edema), it is operator-dependent and lacks the specificity of a biopsy. It is often used as a screening tool [1]. * **CT Angiography (Option C) & MRI (Option D):** These are useful for detecting large-vessel involvement (e.g., aortitis or subclavian involvement) but lack the resolution to confirm the diagnosis of the temporal artery as reliably as a biopsy. **NEET-PG High-Yield Pearls:** * **Clinical Presentation:** New-onset headache, **jaw claudication** (most specific symptom), and scalp tenderness. * **Associated Condition:** Strongly associated with **Polymyalgia Rheumatica (PMR)** [1]. * **Lab Findings:** Markedly elevated ESR (often >100 mm/hr) and CRP [1]. * **Management Tip:** If GCA is suspected, **start high-dose corticosteroids immediately** to prevent permanent blindness (ischemic optic neuropathy); do not wait for biopsy results [1]. Biopsy remains accurate for up to 1-2 weeks after starting steroids.

Question 1

Deforming polyarthritis is associated with all of the following except?

Accepted Answer

Behcet's syndrome

Answer

Rheumatoid arthritis

Answer

Psoriatic arthritis

Answer

Ankylosing spondylitis

Question 2

A 27-year-old woman presents with a red rash over her cheeks, and pain and swelling in both knees as well as several small joints in her hands. She notes that the rash is worse with sun exposure. Medical evaluation reveals oral ulceration, positive ANA, and 3+ proteinuria. What is the most likely mechanism for the renal damage in this condition?

Accepted Answer

deposition of circulating immune complexes

Answer

vasculitis

Answer

micro-emboli

Answer

anti-basement membrane antibodies

Question 3

True regarding Sjogren's syndrome are all of the following except?

Accepted Answer

Males are commonly affected

Answer

Autoimmune condition

Answer

Progressive destruction of lacrimal and salivary gland

Answer

No single laboratory investigation is pathognomic

Question 4

A patient with rheumatoid arthritis presents with progressive quadriplegia and weakness. The patient has a positive Babinski sign, increased muscle tone in the limbs with exaggerated tendon jerks, and worsening gait. There is no sensory or sphincter involvement. What is the best initial investigation?

Accepted Answer

X-ray of the cervical spine in flexion and extension

Answer

MRI of the brain

Answer

EMG and NCV within 48 hours

Answer

Carotid angiography

Question 5

Clinical features of which of the following include conjunctivitis, urethritis, muco-cutaneous lesions, and arthritis?

Accepted Answer

Behcet's syndrome

Answer

Hodgkin's disease

Answer

Grinspan syndrome

Answer

Ehler-Danlos syndrome

Question 6

Churg-Strauss syndrome is characterized by all the following features EXCEPT:

Accepted Answer

Large-vessel vasculitis

Answer

Allergic rhinitis

Answer

Eosinophilic vasculitis

Answer

Treatment with steroids and immunosuppression

Question 7

Which is the best treatment for an over-producer in chronic gout with kidney impairment?

Accepted Answer

Febuxostat

Answer

Allopurinol

Answer

Uricase

Answer

Benzbromarone

Question 8

What is true about Henoch-Schonlein purpura?

Accepted Answer

IgA deposition in mesangium

Answer

Medium vessel vasculitis

Answer

Renal symptoms start late in the disease

Answer

Low platelet count

Question 9

What is the investigation of choice for the diagnosis of Giant Cell Arteritis?

Accepted Answer

Temporal artery biopsy

Answer

Colour Doppler of temporal artery

Answer

CT Angiography

Answer

MRI

Question 10

Which of the following urine findings are characteristic of Systemic Lupus Erythematosus (SLE)?

Accepted Answer

Proteinuria and RBCs

Answer

Proteinuria and RBC casts

Answer

RBC casts

Answer

LE cells

Rheumatology and Immunology — MCQs

Rheumatology and Immunology — MCQs

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