Rheumatology and Immunology Practice Questions

Q: Which of the following auto antibodies is most likely to be present in a patient with systemic lupus erythematosus?

Anti- ds DNA. ***Anti-ds DNA*** - **Anti-double-stranded DNA (anti-dsDNA)** antibodies are highly specific for **Systemic Lupus Erythematosus (SLE)** and are included in the classification criteria [1]. - Their levels often correlate with disease activity, especially in cases with **lupus nephritis** [1]. *Antiphospholipid* - While **antiphospholipid antibodies** can be present in SLE patients (leading to **secondary antiphospholipid syndrome**), they are not the most characteristic or diagnostic autoantibody for SLE itself. - These antibodies are primarily associated with a **prothrombotic state** and recurrent miscarriages. *Anti-Ro* - **Anti-Ro (SSA) antibodies** are associated with SLE, particularly with **cutaneous lupus**, **neonatal lupus**, and **Sjögren's syndrome**, but they are not as specific as anti-dsDNA for the general diagnosis of SLE [1]. - Patients with anti-Ro antibodies may have a higher risk of **photosensitivity** [1]. *Anti-RNP* - **Anti-RNP antibodies** are found in patients with SLE, but they are most characteristically associated with **Mixed Connective Tissue Disease (MCTD)**. - Their presence in SLE often correlates with less severe renal involvement but may indicate **myositis** or **Raynaud's phenomenon**.

Q: Most characteristic feature of drug induced lupus

Anti histone antibody. Most characteristic feature of drug induced lupus ***Anti histone antibody*** - **Anti-histone antibodies** are present in 95% of patients with **drug-induced lupus (DIL)**, making them the most characteristic serological marker. - While other autoantibodies may be found, anti-histone antibodies are almost pathognomonic when DIL is suspected. *Rare anti-ds DNA* - **Anti-dsDNA antibodies** are characteristic of **systemic lupus erythematosus (SLE)** but are rarely found in DIL [1]. - Their absence helps differentiate DIL from SLE. *Renal involvement* - **Renal involvement** is common in **SLE** but is rare in DIL, with **nephritis** occurring in less than 5% of cases. - This clinical difference is important in distinguishing the two conditions. *All of the options* - This option is incorrect because **rare anti-dsDNA** and **rare renal involvement** are features that help *differentiate* DIL from SLE, rather than being characteristic features of DIL itself.

Q: A 26-year-old pregnant woman presents with arthritis and a malar rash that worsens with sun exposure. She has a low-grade fever and is admitted to the hospital. What is the likely diagnosis?

Systemic Lupus Erythematosus. ***Systemic Lupus Erythematosus*** - The combination of **arthritis**, **malar rash** that worsens with sun exposure (photosensitivity), and a **low-grade fever** in a young woman is highly characteristic of systemic lupus erythematosus (SLE) [1]. - SLE is an **autoimmune disease** with diverse clinical manifestations affecting multiple organ systems [1]. *Lyme disease* - Characterized by a **target-like rash (erythema migrans)**, which is distinct from a malar rash, and often presents with flu-like symptoms. - While Lyme disease can cause arthritis, the presence of a classic malar rash and photosensitivity points away from this diagnosis. *Chloasma* - Also known as the **"mask of pregnancy,"** chloasma is a common skin condition in pregnant women causing dark, discolored patches on the face. - It is a **pigmentation disorder** and does not involve arthritis, fever, or an associated malar rash that worsens with sun exposure. *Steven Johnsons syndrome* - An infrequent, serious systemic reaction to medication or infection, that triggers severe skin and mucous membrane reactions, typically presenting with **widespread blistering** and epidermal detachment. - This is an **acute, severe mucocutaneous reaction** and does not present with the chronic arthritis and photosensitive malar rash seen in this patient.

Q: ANA (antinuclear antibody) is seen in all except:

RA. ***RA*** - While ANA can be positive in a small percentage of RA patients, it is **not a characteristic feature** of rheumatoid arthritis and is found in only 30–50% of cases [1]. - The primary diagnostic markers for RA are **rheumatoid factor (RF)** and **anti-citrullinated protein antibody (ACPA)**. *Systemic sclerosis* - **Antinuclear antibodies (ANA)** are present in over 90% of patients with systemic sclerosis, often with specific patterns like nucleolar or centromere [1]. - This makes ANA a key diagnostic and classification criterion for the disease. *Sjogren's syndrome* - **ANA is positive in 80-90%** of patients with Sjögren's syndrome, making it a very common finding [1]. - Specific autoantibodies like anti-Ro (SSA) and anti-La (SSB) are also frequently present alongside ANA [1]. *SLE* - **ANA is highly sensitive for SLE**, being positive in over 95% of patients with systemic lupus erythematosus [1]. - A negative ANA virtually rules out SLE, making it a crucial screening test [2].

Q: Which of the following is not an extra-articular feature of Rheumatoid arthritis?

Proteinuria. ***Proteinuria*** - While kidney involvement can occur in RA (e.g., secondary amyloidosis, drug-induced nephropathy), **proteinuria** itself is not a direct or typical extra-articular feature of rheumatoid arthritis [1]. - It usually indicates a **complication** or secondary condition rather than a primary manifestation of RA. *Conjunctivitis* - **Sjögren's syndrome**, often associated with RA, can cause **dry eyes** (keratoconjunctivitis sicca), which may be described as conjunctivitis-like symptoms [1]. - **Episcleritis** and **scleritis** are also known ocular manifestations of RA, though less common than dry eyes [1]. *Pleural effusion* - **Rheumatoid pleurisy** leading to pleural effusion is a recognized extra-articular manifestation, often characterized by **low glucose levels** in the pleural fluid. - It can be symptomatic (e.g., chest pain, dyspnea) or asymptomatic. *Weight loss* - **Systemic inflammation** and the catabolic state associated with active RA can lead to generalized **fatigue** and **unintentional weight loss** [1]. - This is a common non-specific extra-articular symptom reflecting disease activity.

Q: Autoimmune diseases associated with Sjögren syndrome are all except?

Addison's disease. ***Addison's disease*** - While an **autoimmune disorder** itself (involving the adrenal glands), Addison's disease is generally **not directly associated** as a co-occurring autoimmune condition with Sjögren's syndrome. - Sjögren's syndrome is primarily characterized by **exocrine gland dysfunction**, specifically affecting lacrimal and salivary glands. *RA* - **Rheumatoid arthritis (RA)** is one of the most common autoimmune diseases found in association with **secondary Sjögren's syndrome**. - Sjögren's syndrome can occur in approximately **10-15% of patients with RA**, highlighting a strong pathogenic link. *SLE* - **Systemic lupus erythematosus (SLE)** frequently coexists with Sjögren's syndrome, often making it challenging to differentiate primary from secondary Sjögren's. - Both conditions share common **autoimmune mechanisms** and autoantibody profiles (e.g., anti-Ro/SSA and anti-La/SSB antibodies). *Mixed connective tissue disorder* - **Mixed connective tissue disease (MCTD)** is characterized by overlapping features of SLE, systemic sclerosis, and polymyositis, and also frequently includes features of **Sjögren's syndrome**. - The presence of **anti-U1-RNP antibodies** is a hallmark of MCTD, and these patients often experience sicca symptoms.

Q: Tophi in gout found in all regions except -

Muscle. Muscle - **Tophi** are typically composed of **monosodium urate crystals** deposited in poorly vascularized tissues [1]. - While muscle can be affected in severe, chronic gout, it is an **atypical location** for primary tophaceous deposits compared to other listed structures. *Joint capsule* - The **joint capsule** is a common site for tophi formation, given its proximity to the affected joints and relatively **poor blood supply** compared to fully vascularized tissues [2]. - Deposits here contribute to **joint destruction** and inflammation [3]. *Articular cartilage* - **Articular cartilage** is avascular and a frequent site for **urate crystal deposition**, contributing to the **erosive changes** seen in chronic gout [1]. - These deposits can lead to **chondrocalcinosis-like features** and progressive joint damage. *Skin* - **Tophi** commonly form in the **subcutaneous tissue** of the skin, especially around the ears, fingers, toes, and elbows [2]. - They appear as **firm, whitish nodules** and are a hallmark of chronic tophaceous gout [2].

Q: C.R.E.S.T syndrome is?

Limited scleroderma. ***Limited scleroderma*** - CREST syndrome is an acronym for **Calcinosis**, **Raynaud's phenomenon**, **Esophageal dysmotility**, **Sclerodactyly**, and **Telangiectasias**, which are the hallmark features of **limited cutaneous systemic sclerosis**. - Its clinical presentation is distinguished by skin thickening that affects only the **distal extremities** (below the elbows and knees) and the face. - This is the **most specific answer** as CREST syndrome is synonymous with limited scleroderma. *Localised scleroderma* - This typically presents as **morphea** or **linear scleroderma**, which are benign forms of scleroderma largely confined to the skin without systemic involvement. - It does not involve the characteristic internal organ manifestations or the full spectrum of features seen in CREST syndrome. *Generalised scleroderma* - This term is often synonymous with **diffuse cutaneous systemic sclerosis**, a more severe form where skin thickening extends to the trunk and proximal extremities. - It involves a higher risk of early and severe **internal organ involvement**, differentiating it from the more benign course of limited scleroderma. *Systemic sclerosis* - While CREST syndrome is technically a subtype of systemic sclerosis (specifically the limited cutaneous form), this option is **too broad** and does not specifically define what CREST syndrome represents. - Systemic sclerosis encompasses both **limited (CREST)** and **diffuse forms**, which have different prognoses and patterns of organ involvement. - "Limited scleroderma" is the more **precise and preferred answer** for CREST syndrome.

Q: In Raynaud's disease true is :

More common in female. ***More common in female*** - **Raynaud's phenomenon** is far more prevalent in **females**, particularly those between puberty and 40 years of age. - This **female predominance** is a key epidemiological feature, with an estimated female-to-male ratio as high as 9:1. *Sup. thrombophlebitis* - **Superficial thrombophlebitis** is the inflammation of a superficial vein due to a **blood clot**, which is not a typical manifestation or direct association of Raynaud's disease. - Raynaud's primarily involves **vasospasm** of small arteries, not thrombotic events in superficial veins. *Lower limb more commonly involved than upper limb* - **Raynaud's phenomenon** predominantly affects the **fingers and toes** (acral parts), with **upper limbs** being more commonly involved than the lower limbs, or at least equally, but not less. - Involvement of the **fingers** is the hallmark of the condition. *Associated with migraine* - While both **migraine** and **Raynaud's phenomenon** involve **vascular dysfunction** and are more prevalent in women, a direct, consistent, and causal association is not definitively established as a defining characteristic of Raynaud's disease itself. - Some studies suggest a higher comorbidity, but it isn't a universally true defining feature.

Q: Specific antibody for SLE is -

Anti ds DNA. ***Anti ds DNA*** - **Anti-dsDNA antibodies** are highly specific for **Systemic Lupus Erythematosus (SLE)** and are included in the diagnostic criteria. [1] - Their presence often correlates with **disease activity**, particularly with lupus nephritis. [1] *Anti-La* - **Anti-La (SS-B) antibodies** are primarily associated with Sjögren's Syndrome, though they can also be seen in SLE. [1] - They are considered a more specific marker for **Sjögren's Syndrome** than for SLE. *Anti-Jo* - **Anti-Jo-1 antibodies** are characteristic of **polymyositis** and dermatomyositis, particularly associated with interstitial lung disease in these conditions. - They are not typically found in SLE and are not a diagnostic marker for the disease. *Anti-Ro* - **Anti-Ro (SS-A) antibodies** are commonly found in Sjögren's Syndrome and are also associated with **subacute cutaneous lupus erythematosus (SCLE)** and neonatal lupus. [1] - While present in a significant percentage of SLE patients, they are not as specific as anti-dsDNA antibodies for the diagnosis of SLE itself. [1]

Question 1

Which of the following auto antibodies is most likely to be present in a patient with systemic lupus erythematosus?

Accepted Answer

Anti- ds DNA

Answer

Antiphospholipid

Answer

Anti-Ro

Answer

Anti-RNP

Question 2

Most characteristic feature of drug induced lupus

Accepted Answer

Anti histone antibody

Answer

Rare anti-ds DNA

Answer

Renal involvement

Answer

All of the options

Question 3

A 26-year-old pregnant woman presents with arthritis and a malar rash that worsens with sun exposure. She has a low-grade fever and is admitted to the hospital. What is the likely diagnosis?

Accepted Answer

Systemic Lupus Erythematosus

Answer

Lyme disease

Answer

Chloasma

Answer

Steven Johnsons syndrome

Question 4

ANA (antinuclear antibody) is seen in all except:

Accepted Answer

RA

Answer

Systemic sclerosis

Answer

Sjogren's syndrome

Answer

SLE

Question 5

Which of the following is not an extra-articular feature of Rheumatoid arthritis?

Accepted Answer

Proteinuria

Answer

Conjunctivitis

Answer

Pleural effusion

Answer

Weight loss

Question 6

Autoimmune diseases associated with Sjögren syndrome are all except?

Accepted Answer

Addison's disease

Answer

RA

Answer

SLE

Answer

Mixed connective tissue disorder

Question 7

Tophi in gout found in all regions except -

Accepted Answer

Muscle

Answer

Joint capsule

Answer

Articular cartilage

Answer

Skin

Question 8

C.R.E.S.T syndrome is?

Accepted Answer

Limited scleroderma

Answer

Localised scleroderma

Answer

Generalised scleroderma

Answer

Systemic sclerosis

Question 9

In Raynaud's disease true is :

Accepted Answer

More common in female

Answer

Sup. thrombophlebitis

Answer

Lower limb more commonly involved than upper limb

Answer

Associated with migraine

Question 10

Specific antibody for SLE is -

Accepted Answer

Anti ds DNA

Answer

Anti-La

Answer

Anti-Jo

Answer

Anti-Ro

Rheumatology and Immunology — MCQs

Rheumatology and Immunology — MCQs

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