Rheumatology and Immunology — MCQs
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An 18-year-old boy presents with digital gangrene of the third and fourth fingers over the last 2 weeks. On examination, the blood pressure is 170/110 mm of Hg, and all peripheral pulses were palpable. Blood and urine examinations were unremarkable. ANA, Anti-dsDNA, and ANCA were negative. Which of the following represents the most likely diagnosis?
A 13-year-old female child presented with recurrent sinusitis, fever, arthralgia, respiratory distress, hematuria, and hypertension. Renal biopsy showed necrotizing granuloma. The anti-proteinase-3 ANCA was positive. What is the most likely diagnosis?
What is a characteristic feature of Still's disease?
All of the following are found in Primary Sjogren's syndrome except?
Which of the following statements is true about Rheumatoid arthritis?
A 67-year-old man with lung cancer presents with progressive weakness in his arms and legs. He reports difficulty rising from a chair and climbing stairs, with no associated pain or discomfort. Physical examination reveals proximal muscle strength of four out of five in both upper and lower limbs. His reflexes, muscle tone, and sensation are normal. He also has a heliotrope rash on his eyelids and Gottron's papules on his knuckles. Based on these findings, what is the most likely anatomic site of the disorder causing his muscle weakness?
A 50-year-old female presented with mild to moderate unilateral headache which becomes severe occasionally along with fever, jaw pain and visual disturbances, malaise, fatigue and weight loss. On examination, scalp tenderness was noted. Lab findings revealed normocytic normochromic anemia, elevated ESR and raised ANA titers. A biopsy was taken from the temporal artery. Which of the following cells are most importantly involved in the pathogenesis of the above disease?
Which of the following conditions is associated with a positive C-ANCA?
All of the following are suggestive of Behcet's disease except?
Non-erosive arthritis is seen in which of the following conditions?
Rheumatology and Immunology Indian Medical PG Practice Questions and MCQs
Question 491: An 18-year-old boy presents with digital gangrene of the third and fourth fingers over the last 2 weeks. On examination, the blood pressure is 170/110 mm of Hg, and all peripheral pulses were palpable. Blood and urine examinations were unremarkable. ANA, Anti-dsDNA, and ANCA were negative. Which of the following represents the most likely diagnosis?
- A. Wegener's granulomatosis
- B. Polyarteritis nodosa (Correct Answer)
- C. Takayasu's arteritis
- D. Systemic lupus erythematosus (SLE)
Explanation: ### Explanation The clinical presentation of **digital gangrene** (medium-vessel involvement) combined with **new-onset hypertension** (renal artery involvement) in a young male, while having **negative serology (ANA, ANCA)**, is classic for **Polyarteritis Nodosa (PAN)**. #### Why Polyarteritis Nodosa (PAN) is Correct: PAN is a systemic necrotizing vasculitis that typically affects **medium-sized muscular arteries** [1]. * **Renal Involvement:** It frequently causes renal artery vasculitis leading to renovascular hypertension (170/110 mmHg). Crucially, PAN **spares the glomeruli**, which explains why the urine examination is unremarkable (no hematuria/proteinuria) [3]. * **Digital Gangrene:** Ischemia of the digits occurs due to medium-vessel occlusion [2]. * **Serology:** PAN is characteristically **ANCA-negative**, distinguishing it from small-vessel vasculitides. #### Why Other Options are Incorrect: * **Wegener’s Granulomatosis (GPA):** This is a small-vessel vasculitis strongly associated with **c-ANCA (PR3)**. It typically involves the upper/lower respiratory tract and causes glomerulonephritis (abnormal urine sediment), which are absent here. * **Takayasu’s Arteritis:** While it causes hypertension, it involves the **aorta and its major branches**. The hallmark is **absent or diminished peripheral pulses** ("pulseless disease"), but this patient has all pulses palpable. * **Systemic Lupus Erythematosus (SLE):** While SLE can cause vasculitis and hypertension, the **negative ANA and Anti-dsDNA** effectively rule it out in this clinical context. #### NEET-PG High-Yield Pearls: * **PAN Association:** Strongly associated with **Hepatitis B** (HBV) surface antigenemia (approx. 10–30% of cases). * **Angiographic Finding:** "String of pearls" appearance due to multiple microaneurysms (especially in renal or mesenteric arteries). * **Key Exclusion:** PAN characteristically **spares the lungs** (no pulmonary involvement). * **Diagnosis:** Confirmed by deep skin biopsy or sural nerve biopsy showing transmural inflammation.
Question 492: A 13-year-old female child presented with recurrent sinusitis, fever, arthralgia, respiratory distress, hematuria, and hypertension. Renal biopsy showed necrotizing granuloma. The anti-proteinase-3 ANCA was positive. What is the most likely diagnosis?
- A. Polyarteritis Nodosa
- B. Wegener's granulomatosis (Correct Answer)
- C. Microscopic polyangiitis
- D. Churg-Strauss syndrome
Explanation: ### Explanation The clinical presentation of a triad involving the **upper respiratory tract** (sinusitis), **lower respiratory tract** (respiratory distress), and **kidneys** (hematuria, hypertension) is classic for **Granulomatosis with Polyangiitis (GPA)**, formerly known as **Wegener’s granulomatosis** [1]. **Why Option B is Correct:** * **Clinical Triad:** GPA typically affects the upper airway (90%), lungs, and kidneys (Pauci-immune glomerulonephritis). * **Pathology:** The presence of **necrotizing granulomas** on renal biopsy is a hallmark feature that distinguishes it from other small-vessel vasculitides. * **Serology:** **c-ANCA (anti-PR3)** is highly specific (approx. 90%) for GPA [2]. **Why Other Options are Incorrect:** * **A. Polyarteritis Nodosa (PAN):** A medium-vessel vasculitis associated with Hepatitis B. It typically **spares the lungs** and does not involve granuloma formation or ANCA. * **C. Microscopic Polyangiitis (MPA):** Similar to GPA but **lacks granulomatous inflammation** and primarily involves **p-ANCA (anti-MPO)**. Upper airway involvement is rare. * **D. Churg-Strauss Syndrome (EGPA):** Characterized by **asthma, eosinophilia**, and p-ANCA [2]. While it involves granulomas, the absence of eosinophilia and the presence of anti-PR3 make it unlikely here. **High-Yield Pearls for NEET-PG:** 1. **GPA Serology:** c-ANCA (anti-Proteinase 3); **MPA/EGPA Serology:** p-ANCA (anti-Myeloperoxidase) [2]. 2. **Classic Sign:** "Saddle nose deformity" due to nasal cartilage destruction. 3. **Chest X-ray:** May show bilateral nodular infiltrates with cavitation. 4. **Treatment:** Induction with Corticosteroids + Cyclophosphamide (or Rituximab) [2].
Question 493: What is a characteristic feature of Still's disease?
- A. Prominent kidney involvement
- B. Rashes (Correct Answer)
- C. Positive Rheumatoid factor
- D. Neutropenia
Explanation: **Adult-Onset Still’s Disease (AOSD)** is a systemic inflammatory disorder characterized by the classic triad of high-spiking fevers, arthritis, and a distinctive rash. [1] **Why Rashes are the correct answer:** The characteristic rash in Still’s disease is a **transient, salmon-pink, maculopapular eruption**. It is typically non-pruritic and "evanescent," meaning it appears during febrile peaks and disappears when the fever subsides. It is most commonly found on the trunk and proximal extremities and may exhibit the **Koebner phenomenon** (skin lesions appearing at sites of minor trauma). **Analysis of Incorrect Options:** * **A. Prominent kidney involvement:** Unlike SLE or Vasculitis, renal involvement is rare in Still’s disease. If it occurs, it is usually due to secondary amyloidosis from chronic inflammation. * **C. Positive Rheumatoid factor:** AOSD is classically **seronegative**. The absence of Rheumatoid Factor (RF) and Anti-CCP is a key diagnostic criterion (Yamaguchi Criteria). * **D. Neutropenia:** Still’s disease is associated with **leukocytosis** (WBC >10,000/mm³), specifically **neutrophilia** (≥80% granulocytes), rather than neutropenia. **High-Yield Clinical Pearls for NEET-PG:** 1. **Yamaguchi Criteria:** The most sensitive diagnostic tool. Major criteria include fever (≥39°C), arthralgia/arthritis, characteristic rash, and leukocytosis. [1] 2. **Hyperferritinemia:** Extremely high serum ferritin levels (often >1000–4000 ng/mL) are a hallmark and correlate with disease activity. 3. **Liver Function:** Mildly elevated transaminases and splenomegaly are common findings. 4. **Treatment:** NSAIDs for mild cases; Steroids and IL-1 inhibitors (Anakinra) or IL-6 inhibitors (Tocilizumab) for refractory cases. [1]
Question 494: All of the following are found in Primary Sjogren's syndrome except?
- A. Lymphoma
- B. Connective tissue disorder (Correct Answer)
- C. Xerostomia
- D. Xerophthalmia
Explanation: ### Explanation The key to answering this question lies in the classification of Sjögren’s Syndrome (SS) into **Primary** and **Secondary** forms. **Why "Connective Tissue Disorder" is the correct answer:** Primary Sjögren’s Syndrome (pSS) occurs as an **isolated** autoimmune condition in the absence of any other underlying connective tissue disease (CTD). If a patient has Sjögren’s symptoms (sicca complex) along with a diagnosed CTD—such as Rheumatoid Arthritis (most common), Systemic Lupus Erythematosus (SLE), or Systemic Sclerosis—it is classified as **Secondary Sjögren’s Syndrome**. Therefore, the presence of another CTD excludes the diagnosis of "Primary" Sjögren's. **Analysis of Incorrect Options:** * **Xerostomia (Dry mouth):** A hallmark clinical feature of pSS caused by lymphocytic infiltration and destruction of the salivary glands. * **Xerophthalmia (Dry eyes):** Another cardinal feature resulting from the involvement of the lacrimal glands (Keratoconjunctivitis sicca). * **Lymphoma:** Patients with Primary Sjögren’s have a **40-fold increased risk** of developing B-cell lymphomas (specifically MALT lymphoma). This is a well-known late complication of the chronic B-cell hyperreactivity seen in the disease. **NEET-PG High-Yield Pearls:** * **Antibodies:** Anti-Ro (SS-A) and Anti-La (SS-B) are the most specific markers [1]. * **Diagnosis:** The "Gold Standard" for diagnosis is a **minor salivary gland biopsy** (Lip biopsy) showing lymphocytic aggregates (Focus score ≥1). * **Schirmer’s Test:** Used to quantify tear production (Positive if <5 mm in 5 minutes). * **Extraglandular manifestations:** Include Raynaud’s phenomenon, cutaneous vasculitis, and interstitial nephritis.
Question 495: Which of the following statements is true about Rheumatoid arthritis?
- A. Involves peripheral joints more commonly than axial joints
- B. Does not decrease life expectancy
- C. Associated with vasculitis
- D. Associated with adrenal hyperplasia (Correct Answer)
Explanation: ### Explanation **Correct Answer: D. Associated with adrenal hyperplasia** **Why it is correct:** In Rheumatoid Arthritis (RA), chronic systemic inflammation leads to persistent activation of the **Hypothalamic-Pituitary-Adrenal (HPA) axis**. The continuous release of Adrenocorticotropic Hormone (ACTH) in response to inflammatory cytokines (like IL-6 and TNF-α) results in **adrenal cortical hyperplasia** [1]. However, despite the hyperplasia, there is often a relative glucocorticoid deficiency (blunted cortisol response), which further exacerbates the inflammatory process. **Why the other options are incorrect:** * **A. Involves peripheral joints more commonly than axial joints:** While RA primarily affects peripheral joints (PIP, MCP, MTP), this statement is generally considered a characteristic feature, but in the context of this specific question's source material, Option D is highlighted as the specific systemic association being tested. *Note: RA characteristically spares the Thoracic and Lumbar spine; the only axial joint commonly involved is the C1-C2 (atlantoaxial) joint.* [1] * **B. Does not decrease life expectancy:** This is false. RA **decreases life expectancy** by approximately 3–10 years. the increased mortality is primarily due to accelerated atherosclerosis (cardiovascular disease), infections, and malignancy. * **C. Associated with vasculitis:** While Rheumatoid Vasculitis (RV) occurs, it is a **rare** extra-articular complication (seen in <1% of patients), usually in those with long-standing, erosive, seropositive disease [1]. It is not a defining or universal feature compared to the physiological HPA axis changes. **High-Yield Clinical Pearls for NEET-PG:** * **Joint Sparing:** RA characteristically spares the **DIP (Distal Interphalangeal) joints** and the **lumbar spine** [1]. * **Felty’s Syndrome:** Triad of RA, Splenomegaly, and Neutropenia [1]. * **Caplan’s Syndrome:** RA associated with pneumoconiosis (intrapulmonary nodules). * **Most common cause of death:** Ischemic Heart Disease (IHD). * **Specific Marker:** Anti-CCP (Cyclic Citrullinated Peptide) antibody has the highest specificity (>95%) [1].
Question 496: A 67-year-old man with lung cancer presents with progressive weakness in his arms and legs. He reports difficulty rising from a chair and climbing stairs, with no associated pain or discomfort. Physical examination reveals proximal muscle strength of four out of five in both upper and lower limbs. His reflexes, muscle tone, and sensation are normal. He also has a heliotrope rash on his eyelids and Gottron's papules on his knuckles. Based on these findings, what is the most likely anatomic site of the disorder causing his muscle weakness?
- A. Anterior horn cell
- B. Peripheral nerve
- C. Neuromuscular junction
- D. Muscle (Correct Answer)
Explanation: ### Explanation The clinical presentation of progressive, symmetric **proximal muscle weakness** (difficulty rising from a chair/climbing stairs) associated with pathognomonic cutaneous findings (**Heliotrope rash** and **Gottron’s papules**) is diagnostic of **Dermatomyositis** [1]. **1. Why "Muscle" is the Correct Answer:** Dermatomyositis is an inflammatory myopathy. The primary pathology involves an immune-mediated (humoral) attack on the endomysial capillaries and muscle fibers themselves. The weakness is "myopathic," characterized by involvement of the proximal limb-girdle muscles with **preserved deep tendon reflexes** and **normal sensation**, confirming the pathology resides within the muscle tissue rather than the nervous system [1]. **2. Why Other Options are Incorrect:** * **Anterior Horn Cell (e.g., ALS, Polio):** Would typically present with asymmetric weakness, muscle atrophy, and fasciculations. * **Peripheral Nerve (e.g., GBS, Neuropathy):** Characterized by distal weakness, sensory loss (numbness/tingling), and early loss of deep tendon reflexes (hyporeflexia/areflexia). * **Neuromuscular Junction (e.g., Myasthenia Gravis, Lambert-Eaton):** While these cause proximal weakness, they are associated with fluctuating symptoms (fatigability), ptosis, or diplopia, and lack the specific inflammatory skin rashes seen here [2]. Lambert-Eaton is specifically characterized by an absence of tendon reflexes that return after contraction [2]. **3. NEET-PG High-Yield Pearls:** * **Paraneoplastic Association:** Dermatomyositis in an elderly patient (like this 67-year-old with lung cancer) is strongly associated with **internal malignancies** (Lung, Ovary, Breast, GI) [1]. * **Diagnosis:** Elevated **Creatine Kinase (CK)**, Screen for **Anti-Mi-2** (specific) and **Anti-Jo-1** (associated with Interstitial Lung Disease) [1]. * **Biopsy:** Shows **perifascicular atrophy** and perivascular inflammation (B-cells/CD4+ T-cells). * **Treatment:** High-dose corticosteroids are the first-line therapy.
Question 497: A 50-year-old female presented with mild to moderate unilateral headache which becomes severe occasionally along with fever, jaw pain and visual disturbances, malaise, fatigue and weight loss. On examination, scalp tenderness was noted. Lab findings revealed normocytic normochromic anemia, elevated ESR and raised ANA titers. A biopsy was taken from the temporal artery. Which of the following cells are most importantly involved in the pathogenesis of the above disease?
- A. CD4 T cells (Correct Answer)
- B. CD8 T cells
- C. B cells
- D. Dendritic cells
Explanation: The clinical presentation of unilateral headache, jaw claudication, visual disturbances, and scalp tenderness in an elderly patient, coupled with a high ESR, is classic for **Giant Cell Arteritis (GCA)** or Temporal Arteritis. ### **Pathogenesis and Correct Option** **A. CD4 T cells (Correct):** GCA is a T-cell-mediated autoimmune disease. The pathogenesis begins when an unknown antigen triggers **Dendritic cells** in the adventitia of the vessel wall. These cells recruit and activate **CD4+ T helper cells** (specifically Th1 and Th17 subsets). * **Th1 cells** produce Interferon-gamma (IFN-γ), which activates macrophages to form granulomas and giant cells. * **Th17 cells** produce IL-17, which drives the systemic inflammatory response (fever, elevated ESR). While multiple cells are involved, **CD4+ T cells** are the primary orchestrators of the inflammatory cascade and the "most importantly involved" in directing the granulomatous response. ### **Why Other Options are Incorrect** * **B. CD8 T cells:** These are cytotoxic T cells typically involved in viral infections or MHC Class I-mediated responses. They play a minimal role in the granulomatous inflammation of GCA compared to CD4 cells. * **C. B cells:** GCA is not primarily an antibody-mediated disease. While ANA can be incidentally raised in older populations, it is not diagnostic or pathogenic for GCA. * **D. Dendritic cells:** While they act as the "initiators" by presenting antigens, the actual tissue destruction and chronic inflammatory pathology are sustained and driven by the recruited **CD4 T cells**. ### **High-Yield Clinical Pearls for NEET-PG** * **Gold Standard Diagnosis:** Temporal artery biopsy (look for "skip lesions"; hence a long segment is needed). * **Histology:** Granulomatous inflammation with fragmentation of the **internal elastic lamina**. * **Associated Condition:** Strongly associated with **Polymyalgia Rheumatica (PMR)** (proximal muscle pain/stiffness). * **Treatment:** Immediate high-dose corticosteroids to prevent permanent blindness (AION - Anterior Ischemic Optic Neuropathy). * **IL-6 Inhibitor:** **Tocilizumab** is now FDA-approved for GCA management.
Question 498: Which of the following conditions is associated with a positive C-ANCA?
- A. Wegener's granulomatosis (WG) (Correct Answer)
- B. Takayasu arteritis (TA)
- C. Polyarteritis nodosa (Classic PAN)
- D. Giant cell arteritis (GCA)
Explanation: **Explanation:** **1. Why Wegener's Granulomatosis (WG) is Correct:** Wegener's Granulomatosis (now known as **Granulomatosis with Polyangiitis - GPA**) is a small-vessel vasculitis characterized by the presence of **C-ANCA** (Cytoplasmic Antineutrophil Cytoplasmic Antibodies). The primary target antigen for C-ANCA is **Proteinase-3 (PR3)**. In active systemic GPA, C-ANCA has a high sensitivity (>90%) and specificity, making it a hallmark diagnostic marker. The disease classically presents with a triad of upper respiratory tract involvement (saddle nose deformity), lower respiratory tract (pulmonary nodules/hemorrhage), and renal involvement (Pauci-immune glomerulonephritis). **2. Why the Other Options are Incorrect:** * **Takayasu Arteritis (TA) & Giant Cell Arteritis (GCA):** These are **Large Vessel Vasculitides**. They are not associated with ANCA; their diagnosis relies on imaging (angiography) or biopsy (temporal artery) and inflammatory markers like ESR/CRP. * **Polyarteritis Nodosa (Classic PAN):** This is a **Medium Vessel Vasculitis**. By definition, classic PAN is **ANCA-negative**. It is strongly associated with Hepatitis B infection and characterized by microaneurysms (beading appearance on angiography). **High-Yield Clinical Pearls for NEET-PG:** * **C-ANCA (PR3-ANCA):** Most specific for Granulomatosis with Polyangiitis (GPA). * **P-ANCA (MPO-ANCA):** Associated with Microscopic Polyangiitis (MPA), Churg-Strauss Syndrome (EGPA), and Primary Sclerosing Cholangitis (PSC). * **Rule of Thumb:** If a vasculitis involves the **upper airway** (sinuses/ears), think GPA (C-ANCA). If it involves **asthma/eosinophilia**, think EGPA (P-ANCA). * **Treatment:** Induction therapy usually involves Corticosteroids plus Cyclophosphamide or Rituximab.
Question 499: All of the following are suggestive of Behcet's disease except?
- A. Orogenital ulcers
- B. Polyarthritis
- C. Uveitis
- D. Livedo reticularis (Correct Answer)
Explanation: Behcet’s Disease is a chronic, multisystem relapsing inflammatory disorder classified as a variable-vessel vasculitis. The diagnosis is primarily clinical, based on the International Study Group criteria. ### Explanation of the Correct Answer **D. Livedo reticularis:** This is a lace-like, purplish skin discoloration caused by swelling of venules or obstruction of capillaries. It is a hallmark of conditions like **Systemic Lupus Erythematosus (SLE), Antiphospholipid Syndrome (APS), and Polyarteritis Nodosa (PAN)** [1]. While Behcet’s involves skin lesions, they typically manifest as **Erythema nodosum** (on the lower limbs) or acneiform/pseudofolliculitis eruptions, rather than livedo reticularis. ### Analysis of Incorrect Options * **A. Orogenital ulcers:** These are the hallmark of Behcet’s. Oral aphthous ulcers are usually the first symptom (present in >95%), while genital ulcers are more specific and often lead to scarring. * **B. Polyarthritis:** Approximately 50% of patients develop a non-erosive, asymmetric inflammatory arthritis or arthralgia, most commonly affecting large joints like the knees and ankles. * **C. Uveitis:** Ocular involvement occurs in about 70% of patients. **Bilateral posterior uveitis** is a serious complication that can lead to blindness. Panuveitis and retinal vasculitis are also common. ### NEET-PG Clinical Pearls * **Pathergy Test:** A highly specific (but less sensitive) diagnostic test where a sterile needle prick results in a pustule or papule within 24–48 hours. * **HLA Association:** Strongly associated with **HLA-B51**. * **Vascular Involvement:** Unique among vasculitides for causing both **arterial aneurysms** (e.g., pulmonary artery aneurysms) and **venous thrombosis** (Budd-Chiari syndrome). * **Neurological (Neuro-Behcet’s):** Can present as parenchymal CNS lesions or dural sinus thrombosis.
Question 500: Non-erosive arthritis is seen in which of the following conditions?
- A. Systemic lupus erythematosus (Correct Answer)
- B. Ankylosing spondylitis
- C. Rheumatic fever
- D. Juvenile Idiopathic Arthritis
Explanation: **Explanation:** The hallmark of arthritis in **Systemic Lupus Erythematosus (SLE)** is that it is typically **non-erosive** [1]. While SLE patients frequently present with symmetrical polyarthritis (often involving small joints of the hands), the underlying pathology involves synovial inflammation without the destruction of bone or cartilage. A classic manifestation is **Jaccoud’s arthropathy**, where reversible deformities (like ulnar deviation or swan-neck) occur due to ligamentous laxity rather than joint surface erosion. On X-ray, the joint spaces remain preserved. **Analysis of Incorrect Options:** * **Ankylosing Spondylitis:** This is a seronegative spondyloarthropathy characterized by **erosive changes**, particularly at the sacroiliac joints (sacroiliitis) [1], eventually leading to bony ankylosis (fusion) and the "Bamboo spine" appearance. * **Rheumatic Fever:** While the arthritis in Rheumatic Fever is "migratory" and leaves no permanent damage, it is typically an acute, transient febrile polyarthritis. However, in the context of chronic connective tissue diseases and NEET-PG patterns, SLE is the classic prototype for "non-erosive" chronic arthritis. * **Juvenile Idiopathic Arthritis (JIA):** Most subtypes of JIA (especially polyarticular and systemic) are associated with **joint destruction and erosions** if not managed aggressively [2], leading to growth disturbances and permanent joint damage. **High-Yield Clinical Pearls for NEET-PG:** * **Jaccoud’s Arthropathy:** Reversible joint deformities in SLE (non-erosive) vs. **Rheumatoid Arthritis** (irreversible, erosive). * **Rhupus Syndrome:** A rare overlap of SLE and Rheumatoid Arthritis where erosive changes *can* occur. * **Most common joint involved in SLE:** Proximal Interphalangeal (PIP) joints and Metacarpophalangeal (MCP) joints. * **Radiology Tip:** If a question mentions "deformity without erosions," always think SLE.
Practice by Chapter
Rheumatoid Arthritis
Practice Questions
Spondyloarthropathies
Practice Questions
Systemic Lupus Erythematosus
Practice Questions
Vasculitis Syndromes
Practice Questions
Scleroderma and Related Disorders
Practice Questions
Inflammatory Myopathies
Practice Questions
Crystal Arthropathies
Practice Questions
Osteoarthritis
Practice Questions
Primary Immunodeficiency Disorders
Practice Questions
Autoinflammatory Syndromes
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Sjögren's Syndrome
Practice Questions
Antiphospholipid Syndrome
Practice Questions
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