Rheumatology and Immunology — MCQs

Rheumatology and Immunology Indian Medical PG Practice Questions and MCQs

Question 651: Risk factors associated with development of Gout all except

A. Female sex (Correct Answer)
B. Thiazide
C. High fructose intake
D. Alcohol

Explanation: ***Female sex*** - While gout can affect women, especially post-menopause, **male sex** is a significant and consistent risk factor for gout development due to higher baseline uric acid levels. - Before menopause, **estrogen has a uricosuric effect**, helping to excrete uric acid and protecting against gout. *Thiazide* - **Thiazide diuretics** reduce the excretion of uric acid by the kidneys, leading to **hyperuricemia** and increasing the risk of gout flares [2]. - This medication-induced elevation of uric acid is a well-established risk factor for gout [2]. *High fructose intake* - **Fructose metabolism** increases the production of uric acid by promoting purine degradation while simultaneously reducing its renal excretion [1]. - This dual effect makes high fructose consumption, particularly from sugary drinks, a significant dietary risk factor for gout [1]. *Alcohol* - **Alcohol consumption**, especially beer and spirits, increases uric acid production and reduces its renal excretion, leading to **hyperuricemia** [3]. - This impact on uric acid metabolism makes alcohol a major dietary risk factor for the development of gout [3].

Question 652: Which of the following is commonly seen in SLE?

A. Autoimmune hemolytic anaemia
B. Raynaud's phenomena
C. ↑ed ANA (Correct Answer)
D. Anti-ds DNA
E. Joint deformity

Explanation: ***↑ed ANA*** - A positive **Antinuclear Antibody (ANA)** test is present in over 95% of patients with **Systemic Lupus Erythematosus (SLE)**, making it a highly sensitive screening test [1]. - While not specific to SLE, an elevated ANA is a cornerstone of its diagnostic criteria and indicates the presence of autoantibodies. *Autoimmune hemolytic anaemia* - While **autoimmune hemolytic anemia** can occur in SLE, it is not as universally common as an elevated ANA; it represents one of many potential hematologic manifestations [1]. - It results from autoantibodies targeting red blood cells, leading to their destruction, but is seen in a subset of SLE patients, not nearly all. *Raynaud's phenomena* - **Raynaud's phenomenon** is frequently associated with SLE and other connective tissue diseases, but it is not specific and occurs in many conditions, including primary Raynaud's without underlying disease. - It involves episodic vasospasm of small arteries, typically in the fingers and toes, in response to cold or stress. *Anti-ds DNA* - **Anti-double-stranded DNA (anti-dsDNA)** antibodies are highly specific for SLE and are crucial for diagnosis and monitoring disease activity, especially in lupus nephritis. - However, they are present in about 50-70% of SLE patients, making them less common than a positive ANA [1]. *Joint deformity* - **Joint deformity** can occur in some SLE patients, typically seen as **Jaccoud's arthropathy**, which is a reducible, non-erosive deformity. - Unlike rheumatoid arthritis, erosive joint damage and permanent fixed deformities are rare in SLE, and this is not a universal feature.

Question 653: Kveim test (historical) is used for diagnosis of

A. Wegeners granulomatosis
B. Graves disease
C. Sarcoidosis
D. None of the options (Correct Answer)

Explanation: ***None of the options.*** - While the Kveim test was historically used to diagnose **sarcoidosis**, it is now obsolete. - The Kveim test involved injecting a sarcoid tissue extract and observing for a reaction, but it is no longer used due to concerns about **specificity**, **standardization**, and **transmission of infectious agents**. *Wegeners granulomatosis* - This condition is now known as **Granulomatosis with Polyangiitis (GPA)**. - Diagnosis relies on clinical features, imaging, **biopsy showing granulomatous inflammation and vasculitis**, and **antineutrophil cytoplasmic antibodies (ANCAs)**, particularly **c-ANCA**. *Graves disease* - This is an **autoimmune hyperthyroid condition** diagnosed by specific thyroid hormone levels (low TSH, high free T3/T4) [2]. - The presence of **TSH receptor antibodies (TRAb)** or thyroid-stimulating immunoglobulins (TSI) are key diagnostic markers. *Sarcoidosis* - The Kveim test was indeed historically associated with sarcoidosis, but it is **no longer a current diagnostic tool**. - Current diagnosis involves clinical presentation, **imaging (chest X-ray/CT)** showing bilateral hilar lymphadenopathy, and **biopsy** demonstrating non-caseating granulomas [1].

Question 654: Which of the following is NOT true about gout?

A. Not common in renal disorders
B. Uncommon in teetotalers
C. Uncommon in vegetarians
D. Not found in women after menopause (Correct Answer)

Explanation: **_Not found in women after menopause_** - Gout is actually **more common in women after menopause** due to declining estrogen levels, which can impact uric acid excretion. [2] - **Hyperuricemia** can occur in postmenopausal women, increasing their risk of developing gout. [1] *Not common in renal disorders* - **Renal insufficiency** is a major cause of secondary hyperuricemia because impaired kidney function leads to decreased excretion of uric acid. [1], [3] - Therefore, gout is highly common in individuals with **renal disorders**, making this statement incorrect. [3] *Uncommon in teetotalers* - While alcohol consumption, particularly beer and spirits, is a significant risk factor for gout, it is **not uncommon in teetotalers**. - Other factors like **dietary purine intake**, genetics, and medical conditions can cause gout regardless of alcohol intake. [1] *Uncommon in vegetarians* - This statement is generally true; vegetarians typically have a **lower risk of gout** due to a diet lower in purine-rich animal products. [1] - However, certain plant-based foods, such as some vegetables, legumes, and mushrooms, contain moderate amounts of purines, but typically not enough to significantly increase risk compared to meat-eaters.

Question 655: A middle aged female presents with polyarthritis with elevated rheumatoid factor and ANA levels, which among the following will help you to differentiate rheumatoid arthritis from SLE?

A. Soft tissue swelling at the proximal interphalangeal joint
B. Articular erosions on X-ray (Correct Answer)
C. Elevated ESR
D. Juxta articular osteoporosis on X-ray

Explanation: ***Articular erosions on X-ray*** - Articular erosions are classic radiographic hallmarks of **rheumatoid arthritis (RA)**, indicating destructive changes to cartilage and bone [1]. - While both RA and **Systemic Lupus Erythematosus (SLE)** can cause polyarthritis, erosive disease is characteristic of RA and generally absent in SLE [1]. *Soft tissue swelling at the proximal interphalangeal joint* - **Soft tissue swelling** can occur in both RA and SLE due to inflammation, making it a non-specific finding for differentiation [2]. - Both conditions frequently affect the **proximal interphalangeal (PIP) joints**, causing swelling and tenderness [2]. *Elevated ESR* - An **elevated Erythrocyte Sedimentation Rate (ESR)** is a general marker of inflammation and can be high in both RA and SLE [3]. - It reflects ongoing disease activity but does not help to distinguish between these two specific autoimmune conditions. *Juxta articular osteoporosis on X-ray* - **Juxta-articular osteoporosis** can be seen in both RA due to regional bone loss from inflammation and in SLE, often as a side effect of corticosteroid use. - This finding is therefore not specific enough to definitively differentiate between RA and SLE.

Question 656: Which is not an autoimmune disease

A. SLE
B. Grave's disease
C. Myasthenia Gravis
D. Sickle cell disease (Correct Answer)

Explanation: ***Sickle cell disease*** - This is a **genetic disorder** caused by a mutation in the **beta-hemoglobin gene**, leading to abnormal hemoglobin (hemoglobin S) and sickle-shaped red blood cells. - It is an **inherited blood disorder**, not an autoimmune condition where the immune system attacks the body's own tissues. *SLE (Systemic Lupus Erythematosus)* - SLE is a **chronic autoimmune connective tissue disease** that can affect multiple organ systems. - It is characterized by the production of **autoantibodies** against various self-antigens, such as anti-dsDNA and anti-Sm antibodies. *Grave's disease* - This is an **autoimmune disorder** that leads to **hyperthyroidism**. - It is caused by the production of **autoantibodies** (thyroid-stimulating immunoglobulins) that mimic TSH and stimulate the thyroid gland to produce excessive thyroid hormones. *Myasthenia Gravis* - Myasthenia Gravis is an **autoimmune neuromuscular disease** characterized by fluctuating muscle weakness. - It is caused by **autoantibodies** that block or destroy acetylcholine receptors at the neuromuscular junction, impairing nerve-to-muscle communication.

Question 657: Connective tissue disorder which is associated with gastroesophageal reflux is -

A. Dermatomyositis
B. Scleroderma (Correct Answer)
C. SLE
D. Behcet's syndrome

Explanation: ***Scleroderma*** - **Scleroderma** (systemic sclerosis) frequently involves the gastrointestinal tract due to **fibrosis and vascular damage**, leading to impaired esophageal motility and **gastroesophageal reflux (GERD)** [1]. - The **dysmotility** is caused by the replacement of smooth muscle with **collagen**, particularly in the lower two-thirds of the **esophagus** [1]. *Dermatomyositis* - While dermatomyositis can affect the pharyngeal and upper esophageal muscles, leading to **dysphagia**, it is less commonly and directly associated with **acid reflux** in the generalized digestive tract compared to scleroderma [1]. - It primarily causes **proximal muscle weakness** and characteristic **skin rashes**, rather than widespread visceral fibrosis leading to GERD. *SLE* - **Systemic lupus erythematosus (SLE)** can cause various gastrointestinal symptoms, including **dysphagia** or **abdominal pain**, but **GERD** is not a prominent or characteristic feature of its esophageal involvement. - Gastrointestinal involvement in SLE is often related to **vasculitis** or **serositis**, not the widespread smooth muscle fibrosis seen in scleroderma. *Behcet's syndrome* - **Behcet's syndrome** is characterized by recurrent oral and genital ulcers, uveitis, and skin lesions. - While it can manifest with gastrointestinal symptoms, these typically involve **ulcerations** throughout the GI tract, rather than primary esophageal dysmotility and **GERD**.

Question 658: In which of the following types of arthritis are erosions typically not seen?

A. Rheumatoid arthritis
B. Systemic lupus erythematosus (SLE) (Correct Answer)
C. Psoriasis
D. Gout

Explanation: ***Systemic lupus erythematosus (SLE)*** * SLE arthritis is primarily characterized by **non-erosive** and **non-deforming polyarthritis**, meaning it typically does not cause permanent joint damage or bone erosions [2]. * Joint pain and swelling are common in SLE, but radiographic findings rarely show the destructive changes seen in other inflammatory arthropathies. *Psoriasis* * Psoriatic arthritis often causes **erosive changes** and new bone formation, leading to distinctive radiographic findings such as "pencil-in-cup" deformities [1]. * It is a seronegative spondyloarthropathy that can affect peripheral and axial joints, as well as entheses [1]. *Rheumatoid arthritis* * Rheumatoid arthritis is a classic example of an **erosive arthritis**, where chronic inflammation leads to the destruction of cartilage and subchondral bone [3]. * Radiographic evidence of **joint erosions** is a hallmark feature, particularly in the small joints of the hands and feet [3]. *Gout* * Gout is a crystal-induced arthritis that can cause **erosive changes**, particularly in chronic, untreated cases, often presenting as characteristic "punched-out" erosions with overhanging edges [4]. * These erosions are due to the inflammatory response to **urate crystal deposition** in and around the joints [4].

Question 659: Anticentromere antibodies are most commonly associated with

A. Diffuse cutaneous systemic sclerosis
B. Polymyositis
C. Mixed connective tissue disease
D. CREST syndrome (Correct Answer)

Explanation: ***CREST syndrome*** - **Anticentromere antibodies** are highly specific for **CREST syndrome**, a limited form of systemic sclerosis. [1] - CREST syndrome is an acronym for its characteristic features: **Calcinosis**, **Raynaud's phenomenon**, **Esophageal dysmotility**, **Sclerodactyly**, and **Telangiectasias**. [1] *Diffuse cutaneous systemic sclerosis* - This more severe form of systemic sclerosis is typically associated with **anti-Scl-70 (anti-topoisomerase I)** antibodies. - It involves widespread skin thickening and early, significant internal organ involvement. [1] *Polymyositis* - Polymyositis is an inflammatory myopathy primarily associated with antibodies like **anti-Jo-1** (aminoacyl-tRNA synthetase). [1] - It’s characterized by **proximal muscle weakness** and elevated muscle enzymes. [1] *Mixed connective tissue disease* - This overlap syndrome is defined by the presence of **high titers of anti-U1-RNP** antibodies. [1] - It features signs and symptoms overlapping with systemic lupus erythematosus, systemic sclerosis, and polymyositis. [1]

Question 660: Low complement levels are seen in:

A. All of the above (Correct Answer)
B. MPGN (Membranoproliferative glomerulonephritis)
C. Infective endocarditis
D. PSGN (Post-streptococcal glomerulonephritis)

Explanation: ***All of the above*** - **Low complement levels** are a characteristic feature of several immune-mediated conditions, including **MPGN**, **Infective endocarditis**, and **PSGN**. - Complement activation and consumption, often due to **immune complex formation** [1], lead to depleted complement protein levels. *MPGN (Membranoproliferative glomerulonephritis)* - **MPGN types I and III** are strongly associated with **hypocomplementemia** due to chronic activation and consumption of the complement system [2]. - This is often driven by **circulating immune complexes** or, in type II, by **C3 nephritic factor** causing persistent C3 convertase activity. *Infective endocarditis* - **Immune complex formation** in infective endocarditis can lead to complement activation and subsequent **reduction in C3 and C4 levels** [1]. - This hypocomplementemia is particularly noted in cases with **glomerulonephritis** secondary to infective endocarditis. *PSGN (Post-streptococcal glomerulonephritis)* - **PSGN** is typically characterized by transient but significant **low C3 levels** due to classical and alternative pathway activation by immune complexes containing streptococcal antigens [1]. - **C4 levels** are usually normal or only mildly decreased, distinguishing it from conditions with widespread C1q, C4, and C2 activation.

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

Practice Questions

Sjögren's Syndrome

Practice Questions

Antiphospholipid Syndrome

Practice Questions

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