Rheumatology and Immunology Practice Questions

Q: In long standing rheumatoid arthritis, which condition is commonly observed?

Secondary amyloidosis. ***Secondary amyloidosis*** - Chronic inflammation in **rheumatoid arthritis** can lead to the production and deposition of **amyloid A protein**, which is the hallmark of secondary (AA) amyloidosis [1]. - **Secondary amyloidosis** can affect various organs, including the kidneys, heart, and gastrointestinal tract, leading to organ dysfunction [1]. *Milk alkali syndrome* - This condition is caused by excessive intake of **calcium** and absorbable alkali, resulting in **hypercalcemia** and **metabolic alkalosis**. - It is not directly associated with the chronic inflammatory process of rheumatoid arthritis. *Nephrolithiasis* - **Kidney stones** (nephrolithiasis) are often associated with genetic predispositions, dietary factors, and certain metabolic conditions like **hypercalciuria** or **hyperoxaluria**. - There is no direct causal link between **rheumatoid arthritis** and an increased risk of common types of kidney stones. *Paradoxical aciduria* - This condition is characterized by the excretion of acidic urine in the presence of **metabolic alkalosis**, typically due to **volume depletion** and **hypokalemia**. - While it reflects a disturbance in acid-base balance and renal function, it is not a direct or commonly observed complication of long-standing rheumatoid arthritis itself.

Q: Most common precipitant of Raynaud's phenomenon is

Exposure to cold. ***Exposure to cold*** - **Exposure to cold temperatures**, even mild cold, is the most frequent and characteristic trigger for **vasoconstriction** in Raynaud's phenomenon. - This leads to the classic **triphasic color changes** (white, blue, red) in the digits due to restricted blood flow. *Exposure to heat* - **Exposure to heat** generally causes **vasodilation**, which would alleviate rather than precipitate the symptoms of Raynaud's phenomenon. - While sudden temperature changes can sometimes be a factor, direct heat exposure is not a primary recognized trigger. *Psychosocial triggers* - **Emotional stress** and anxiety can indeed precipitate Raynaud's episodes in some individuals, as the **sympathetic nervous system** plays a role in vasoconstriction. - However, **cold exposure** remains the most common and potent precipitating factor across the majority of cases. *Exertion* - **Physical exertion** typically leads to **vasodilation** in working muscles and increased blood flow to the skin for heat dissipation. - It is not a common or direct precipitant of the localized vasoconstrictive attacks seen in Raynaud's phenomenon.

Q: A 23-year old woman has experienced episodes of myalgias, pleural effusion, pericarditis and arthralgias without joint deformity over course of several years. The best laboratory screening test to diagnose her disease would be -

Antinuclear antibody. ***Antinuclear antibody*** - The constellation of **myalgias**, **pleural effusion**, **pericarditis**, and **arthralgias without joint deformity** is highly suggestive of **systemic lupus erythematosus (SLE)**. - **Antinuclear antibodies (ANA)** are present in over 95% of patients with SLE and are the primary screening test for this condition [1]. *CD4/CD8 lymphocyte count* - This count is more relevant for monitoring **immunodeficiency** conditions like **HIV infection**, where it helps assess immune status. - While lymphocytes can be affected in autoimmune diseases, a CD4/CD8 count is not a primary screening test for SLE. *Erythrocyte sedimentation rate* - An **elevated ESR** indicates general inflammation and is a **non-specific marker** [2]. - While it is often elevated in SLE, it doesn't confirm the diagnosis and can be high in numerous other inflammatory conditions [1]. *Assay for thyroid hormones* - An assay for thyroid hormones is used to diagnose **thyroid disorders** like **hypothyroidism** or **hyperthyroidism**. - There is no direct link between thyroid hormone levels and the symptoms described in the patient.

Q: In a patient presenting with a painful swollen joint and a history of high uric acid levels, which condition is most likely indicated by this clinical presentation?

Gout. ***Gout*** - **Gout** is characterized by sudden, severe attacks of pain, swelling, redness, and tenderness in one or more joints, most often the **big toe** [1],[2]. - A history of **high uric acid levels** (hyperuricemia) is a primary risk factor, as it leads to the formation of **uric acid crystals** in the joint [1],[3]. *Ankylosing spondylitis* - This condition is a chronic inflammatory disease primarily affecting the **spine and sacroiliac joints**, causing stiffness and pain, especially in the morning. - It is not directly associated with **high uric acid levels** or generally presenting as an acute, single swollen joint attack. *Osteoarthritis* - **Osteoarthritis** is a degenerative joint disease characterized by the breakdown of cartilage over time, leading to pain and stiffness, especially with activity. - While it can cause joint swelling, it is typically a gradual process, not an acute, intensely painful attack, and is not linked to **uric acid levels**. *Rheumatoid arthritis* - **Rheumatoid arthritis** is an autoimmune disease causing chronic inflammation, primarily affecting multiple small joints symmetrically. - It presents with prolonged morning stiffness and is not directly caused by **high uric acid levels**, nor is its typical presentation an acute monoarthritis.

Q: Which of the following antibodies is highly specific for systemic lupus erythematosus?

Anti-Sm. ***Anti-Sm*** - The **Anti-Sm antibody** is highly specific for **systemic lupus erythematosus (SLE)**, with a specificity of over 99% [1]. - It is often associated with **renal involvement** and more severe disease manifestations [1]. *Anti-Centromere* - Mostly associated with **limited scleroderma**, not SLE, and indicates **creatodermal** changes. - Often found in patients with **Raynaud's phenomenon** and **pulmonary hypertension**, distinct from SLE features. *Anti-U1RNP* - Typically seen in **mixed connective tissue disease (MCTD)**, indicating a combination of features from various autoimmune diseases [1]. - While it can be present in SLE patients, it is not specific to SLE and can be found in other conditions as well. *Anti-RO-1* - Also known as **Anti-SSA**, these antibodies are associated with Sjögren's syndrome, as well as SLE [1]. - They are not specific for SLE as they can appear in other autoimmune diseases, marking their lack of specificity.

Q: Which of the following statements about drug-induced SLE is NOT true?

Anti-histone antibodies are negative. ***Anti-histone antibodies are negative*** - **Anti-histone antibodies** are actually positive in approximately **95% of drug-induced SLE** cases, making this statement false. - The presence of **anti-histone antibodies** is a hallmark diagnostic feature that helps distinguish drug-induced lupus from other forms of lupus. *CNS involvement not common* - **Central nervous system manifestations** are indeed rare in drug-induced lupus, unlike idiopathic SLE. - This accurately reflects a key differentiating feature, as **neuropsychiatric symptoms** are uncommon in drug-induced variants. *Female:Male = 1:1* - Drug-induced SLE shows **equal gender distribution** (1:1 ratio), contrasting with idiopathic SLE's female predominance. - This lack of **gender predilection** is a characteristic feature that distinguishes it from systemic lupus erythematosus. *Renal involvement not common* - **Renal manifestations** are rare in drug-induced lupus erythematosus, making this statement accurate. - This absence of **lupus nephritis** helps differentiate it from idiopathic SLE, where kidney involvement is frequent and severe.

Q: All of the following are true about Gout, except which of the following?

Occurs more in females. ***Occurs more in females*** - **Gout** is more prevalent in **males** than in females, especially before menopause, due to hormonal differences and lifestyle factors. - After menopause, the incidence in females increases but generally remains lower than in males. *Occurs due to accumulation of urate crystals in joint* - **Gout** is precisely characterized by the **deposition of monosodium urate crystals** in joints and surrounding tissues, leading to inflammation [1], [2]. - This accumulation is a direct consequence of **hyperuricemia**, either from overproduction or underexcretion of uric acid [2], [3]. *Can be precipitated by pyrazinamide* - **Pyrazinamide** is an anti-tuberculosis drug known to **inhibit uric acid excretion** by the kidneys. - This leads to **hyperuricemia**, thereby increasing the risk of acute gout attacks. *Birefringent crystals are present in the joint* - Microscopic examination of **synovial fluid** from a gouty joint reveals **needle-shaped, negatively birefringent crystals** of monosodium urate [1], [4]. - This finding is a definitive diagnostic criterion for **gout**.

Q: What is the primary cause of Common Variable Immunodeficiency (CVID)?

Defective B cell differentiation. ***Defective B cell differentiation*** - CVID is characterized primarily by a failure of **B cells** to differentiate into **plasma cells**, which are responsible for producing antibodies [1]. - This defective differentiation leads to **hypogammaglobulinemia**, or low levels of immunoglobulins [1]. *Absent B cells* - Complete absence of B cells is characteristic of severe combined immunodeficiency (SCID) or X-linked agammaglobulinemia (XLA), not CVID [1]. - In CVID, B cells are typically present, but they are dysfunctional. *Reduced number of B cells* - While some patients with CVID may have reduced B cell numbers, this is not the primary or defining defect. - The key issue is the inability of existing B cells to mature and produce antibodies effectively. *Defective B cell function* - While B cell function is indeed defective in CVID, the root cause of this malfunction is specifically the **failure of differentiation** into mature plasma cells. - The B cells are unable to perform their primary function of antibody production due to this arrest in their development.

Q: Which of the following is a key feature of microscopic polyangiitis?

Renal involvement in 80% of cases. ***Renal involvement in 80% of cases*** - Microscopic polyangiitis is characterized by significant **renal involvement**, with **glomerulonephritis** seen in approximately **80%** of patients. - The condition is associated with **pauci-immune** vasculitis, leading to **rapidly progressive renal failure** [1]. *Bronchospasm* - While bronchospasm can occur in various allergic and respiratory conditions, it is not a classical feature of microscopic polyangiitis. - The disease primarily affects **small vessels** and is not associated with **airway hyperreactivity**. *All of the above* - This option is incorrect as not all listed choices correctly represent features of microscopic polyangiitis. - Specifically, **bronchospasm** and **IgG deposits in the kidney** are not typical indicators of the condition. *IgG deposits in kidney* - Microscopic polyangiitis generally presents with **pauci-immune** glomerulonephritis, often with no significant **IgG deposits** on immunofluorescence [1]. - Renal pathology typically shows **crescentic lesions**, not IgG-mediated damage [1].

Q: Shrinking Lung Syndrome is seen in:

SLE. ***SLE*** - **Shrinking lung syndrome (SLS)** is a rare but recognized pulmonary manifestation of **systemic lupus erythematosus (SLE)** [1]. - It is characterized by **dyspnea**, **pleuritic chest pain**, and elevated diaphragms with reduced lung volumes, often without significant interstitial lung disease [1]. *Rheumatoid Arthritis* - While **rheumatoid arthritis** can cause various lung manifestations like **interstitial lung disease (ILD)**, pleural effusions, and rheumatoid nodules, **shrinking lung syndrome** is not typically associated with it [2]. - Lung disease in RA often involves **pulmonary fibrosis** or bronchiolitis, differing from the restrictive physiology of SLS. *Scleroderma* - **Scleroderma (Systemic Sclerosis)** commonly affects the lungs, primarily leading to **interstitial lung disease (ILD)** and **pulmonary hypertension** [1]. - **Shrinking lung syndrome**, with its characteristic restrictive pattern and elevated diaphragms, is not a typical presentation of lung involvement in scleroderma. *Sarcoidosis* - **Sarcoidosis** is characterized by the formation of **non-caseating granulomas**, primarily affecting the lungs and lymph nodes. - Lung involvement in sarcoidosis typically presents as **interstitial lung disease** or nodular infiltrates, not the distinct features of **shrinking lung syndrome** [3].

Question 1

In long standing rheumatoid arthritis, which condition is commonly observed?

Accepted Answer

Secondary amyloidosis

Answer

Milk alkali syndrome

Answer

Nephrolithiasis

Answer

Paradoxical aciduria

Question 2

Most common precipitant of Raynaud's phenomenon is

Accepted Answer

Exposure to cold

Answer

Exposure to heat

Answer

Psychosocial triggers

Answer

Exertion

Question 3

A 23-year old woman has experienced episodes of myalgias, pleural effusion, pericarditis and arthralgias without joint deformity over course of several years. The best laboratory screening test to diagnose her disease would be -

Accepted Answer

Antinuclear antibody

Answer

Erythrocyte sedimentation rate

Answer

Assay for thyroid hormones

Answer

CD4/CD8 lymphocyte count

Question 4

In a patient presenting with a painful swollen joint and a history of high uric acid levels, which condition is most likely indicated by this clinical presentation?

Accepted Answer

Gout

Answer

Ankylosing spondylitis

Answer

Osteoarthritis

Answer

Rheumatoid arthritis

Question 5

Which of the following antibodies is highly specific for systemic lupus erythematosus?

Accepted Answer

Anti-Sm

Answer

Anti-RO-1

Answer

Anti-Centromere

Answer

Anti-U1RNP

Question 6

Which of the following statements about drug-induced SLE is NOT true?

Accepted Answer

Anti-histone antibodies are negative

Answer

CNS involvement not common

Answer

Female:Male = 1:1

Answer

Renal involvement not common

Question 7

All of the following are true about Gout, except which of the following?

Accepted Answer

Occurs more in females

Answer

Can be precipitated by pyrazinamide

Answer

Birefringent crystals are present in the joint

Answer

Occurs due to accumulation of urate crystals in joint

Question 8

What is the primary cause of Common Variable Immunodeficiency (CVID)?

Accepted Answer

Defective B cell differentiation

Answer

Defective B cell function

Answer

Absent B cells

Answer

Reduced number of B cells

Question 9

Which of the following is a key feature of microscopic polyangiitis?

Accepted Answer

Renal involvement in 80% of cases

Answer

All of the options

Answer

IgG deposits in kidney

Answer

Bronchospasm

Question 10

Shrinking Lung Syndrome is seen in:

Accepted Answer

SLE

Answer

Rheumatoid Arthritis

Answer

Scleroderma

Answer

Sarcoidosis

Rheumatology and Immunology — MCQs

Rheumatology and Immunology — MCQs

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