Rheumatology and Immunology — MCQs

Rheumatology and Immunology Indian Medical PG Practice Questions and MCQs

Question 741: Which of the following conditions is an indication for Chrysotherapy?

A. Ankylosing spondylitis
B. Behcet's syndrome
C. Osteoarthritis
D. Rheumatoid arthritis (Correct Answer)

Explanation: The explanation with [3], [1] inline citations added ***Rheumatoid arthritis*** - Chrysotherapy, specifically using **gold salts**, was an early and effective treatment for **rheumatoid arthritis (RA)**, particularly for patients with active and progressive disease. [3] - While less common today due to newer biological agents, gold compounds like **aurothiomalate** and **auranofin** were historically used to reduce inflammation and slow joint damage in RA. [1] *Ankylosing spondylitis* - **Ankylosing spondylitis** is a seronegative spondyloarthropathy primarily affecting the axial skeleton. - Its treatment typically involves **NSAIDs**, **TNF-alpha inhibitors**, and exercise, not chrysotherapy. *Behcet's syndrome* - **Behcet's syndrome** is a systemic vasculitis characterized by recurrent oral ulcers, genital ulcers, and uveitis. - Treatment usually involves **corticosteroids** and **immunosuppressants**, with no indication for chrysotherapy. *Osteoarthritis* - **Osteoarthritis** is a degenerative joint disease involving cartilage breakdown. [2] - Management focuses on **pain relief**, **physical therapy**, and in severe cases, **joint replacement**, and chrysotherapy is not part of its treatment regimen. [2]

Question 742: Triple therapy in Rheumatoid Arthritis involves all except

A. Hydroxychloroquine
B. Sulphasalazine
C. Methotrexate
D. Steroids (Correct Answer)

Explanation: ***Steroids*** - While **steroids** (e.g., **prednisone**) are commonly used in rheumatoid arthritis to control flares and bridge therapy [1], they are not a component of the classic "triple therapy" regimen, which refers to a specific combination of **DMARDs**. - Steroids are typically used for their rapid **anti-inflammatory effects** but carry significant long-term side effects, making them unsuitable for sustained monotherapy or as part of continuous fixed-dose DMARD combinations. *Hydroxychloroquine* - **Hydroxychloroquine** is a foundational component of the traditional "triple therapy" for rheumatoid arthritis, valued for its relatively mild side effect profile. - It works by modulating immune responses and is often combined with other **DMARDs** for synergistic effects. *Sulphasalazine* - **Sulphasalazine** is another key component of the "triple therapy" regimen, particularly useful for its anti-inflammatory and immunomodulatory actions in rheumatoid arthritis. - It helps to reduce joint pain, stiffness, and swelling, working in conjunction with methotrexate and hydroxychloroquine. *Methotrexate* - **Methotrexate** is considered the cornerstone of rheumatoid arthritis treatment and is an essential part of the "triple therapy" combination [1]. - It is a **disease-modifying antirheumatic drug (DMARD)** that effectively slows disease progression and reduces joint damage.

Question 743: "Flexor tendon tenosynovitis" is a hallmark feature of

A. Osteoarthritis
B. Rheumatoid arthritis (Correct Answer)
C. Psoriatic arthritis
D. Ankylosing spondylitis

Explanation: ***Rheumatoid arthritis*** - **Flexor tendon tenosynovitis** is a common inflammatory manifestation in **rheumatoid arthritis**, contributing to symptoms like trigger finger and carpal tunnel syndrome [2]. - It involves inflammation of the **synovial sheath** surrounding the flexor tendons, often seen in the hands and wrists. *Osteoarthritis* - Primarily a **degenerative joint disease** characterized by cartilage breakdown, not inflammation of tendon sheaths. - While osteophytes can lead to mechanical irritation, primary **tendon tenosynovitis** is not a hallmark. *Psoriatic arthritis* - Characterized by **dactylitis** (sausage digits) and enthesitis (inflammation at tendon/ligament insertions), but **flexor tendon tenosynovitis** itself is less distinctive compared to RA [1]. - It often involves asymmetrical joint inflammation and skin/nail psoriasis [1]. *Ankylosing spondylitis* - A form of **spondyloarthritis** primarily affecting the axial skeleton (spine and sacroiliac joints) and entheses. - **Flexor tendon tenosynovitis** is not a typical or hallmark feature of this condition, which is more associated with spinal stiffness and pain.

Question 744: Which of the following is NOT a characteristic feature of Henoch-Schönlein purpura (HSP)?

A. Splinter hemorrhage
B. Thrombocytopenia (Correct Answer)
C. Abdominal pain
D. Epistaxis

Explanation: ***Thrombocytopenia*** - **Thrombocytopenia** is generally **not a feature** of Henoch-Schönlein purpura (HSP); platelet counts are typically **normal** or can even be elevated [1]. - HSP is a **vasculitis**, characterized by **IgA deposition**, leading to palpable purpura, rather than a primary platelet disorder [1]. *Splinter hemorrhage* - **Splinter hemorrhages** are a form of **microembolism** or capillary damage that can occur in various conditions, and while not a cardinal feature, they are more related to vessel damage than thrombocytopenia. - Although less common, any form of **vasculitis-related capillary leakage** could theoretically lead to small hemorrhagic phenomena. *Abdominal pain* - **Abdominal pain** is a very common and significant symptom in HSP, often due to **gastrointestinal vasculitis** leading to bowel wall edema, hemorrhage, or intussusception. - It can range from mild discomfort to severe, colicky pain and may be accompanied by **gastrointestinal bleeding**. *Epistaxis* - **Epistaxis** (nosebleeds) is a possible manifestation of **mucosal vasculitis** in HSP. - It can occur due to damage to superficial blood vessels in the nasal passages as part of the systemic inflammatory process.

Question 745: Distal interphalangeal joints are involved in all except -

A. Rheumatoid arthritis (Correct Answer)
B. Psoriatic arthritis
C. Reactive arthritis
D. Osteoarthritis

Explanation: ***Rheumatoid arthritis*** - **Rheumatoid arthritis** characteristically spares the **distal interphalangeal (DIP) joints** while commonly affecting the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints [1]. - Involvement of the DIP joints would suggest an alternative diagnosis or atypical presentation [5]. *Psoriatic arthritis* - **Psoriatic arthritis** frequently involves the **DIP joints**, leading to classic "sausage digits" (dactylitis) and nail changes [1]. - It often gives a "pencil-in-cup" appearance on X-ray due to erosions at these joints [3]. *Reactive arthritis* - **Reactive arthritis** can affect any joint, including the **DIP joints**, although it more commonly presents in a **mono- or oligoarticular** pattern, predominantly in the lower limbs [4]. - The pattern of joint involvement is typically asymmetric [4]. *Osteoarthritis* - **Osteoarthritis** commonly affects the **DIP joints**, leading to the formation of **Heberden's nodes** (bony enlargements at the DIP joints) [2]. - This is a hallmark feature of generalized osteoarthritis, especially in the hands [2].

Question 746: True statement about Rheumatic fever in children -

A. MC valve involvement is Aortic
B. Polyarthritis is the most common major manifestation (Correct Answer)
C. Caused by Group A beta-hemolytic streptococci
D. Erythema marginatum is the most common manifestation

Explanation: ***Polyarthritis is the most common major manifestation*** - **Polyarthritis** is a migratory inflammation of large joints, typically affecting more than one joint simultaneously or in quick succession, and is indeed the most frequent major manifestation of acute rheumatic fever in children. - It affects about **60-80%** of children with episodes of rheumatic fever, usually resolving without permanent joint damage. *MC valve involvement is Aortic* - The **mitral valve** is the most commonly affected heart valve in rheumatic fever, experiencing damage in 50-70% of cases [1]. - While the aortic valve can be involved, it is less common than mitral valve involvement, with tricuspid and pulmonary valves being affected least frequently. *Caused by Group A beta-hemolytic streptococci* - Acute rheumatic fever is an **autoimmune inflammatory process** that occurs as a sequela of an untreated or inadequately treated infection with Group A Streptococcus (GAS), not directly caused by the bacteria [1]. - The immune response to GAS (specifically *Streptococcus pyogenes*) leads to **molecular mimicry**, where antibodies mistakenly attack host tissues, primarily the heart, joints, brain, and skin [2]. *Erythema marginatum is the most common manifestation* - **Erythema marginatum** is a rare rash associated with rheumatic fever, characterized by red rings or crescent-shaped lesions with clear centers, primarily seen on the trunk and proximal extremities. - It is one of the **minor manifestations** and occurs in less than 5% of cases, making it far from the most common overall manifestation (major or minor).

Question 747: All of the following features may be used to distinguish PAN from microscopic polyangitis, except:

A. RBC cast in urine
B. ANCA positivity
C. HBV infection
D. Necrotizing vasculitis (Correct Answer)

Explanation: ***Necrotizing vasculitis*** - Both **polyarteritis nodosa (PAN)** and **microscopic polyangiitis (MPA)** are characterized by **necrotizing vasculitis**, making it a shared feature rather than a distinguishing one. [1] - This pathological finding describes the **inflammation** and **necrosis** of vessel walls, which is central to the pathogenesis of both conditions. [1] *RBC cast in urine* - **Red blood cell (RBC) casts** in the urine are indicative of **glomerulonephritis**, which is a prominent feature of **microscopic polyangiitis (MPA)** but typically absent in **polyarteritis nodosa (PAN)**. [1] - The presence of RBC casts points to **renal involvement**, particularly in the small vessels of the glomeruli, which distinguishes MPA's pattern of injury. [1] *ANCA positivity* - **Anti-neutrophil cytoplasmic antibodies (ANCAs)**, particularly **p-ANCA (MPO-ANCA)**, are frequently positive in **microscopic polyangiitis (MPA)** but usually negative in **polyarteritis nodosa (PAN)**. - ANCA positivity helps classify MPA as an **ANCA-associated vasculitis**, a distinction not typically applied to PAN. *HBV infection* - **Hepatitis B virus (HBV) infection** is strongly associated with a significant subset of **polyarteritis nodosa (PAN)** cases, whereas this association is rare in **microscopic polyangiitis (MPA)**. - Serological testing for HBV can therefore help differentiate between the two conditions, with a positive result favoring PAN.

Question 748: Which of the following is NOT a connective tissue disorder?

A. Osteoarthritis
B. Fibromyalgia
C. Sjogren's syndrome (Correct Answer)
D. SLE

Explanation: ***Sjogren's syndrome*** - Sjogren's syndrome is an **autoimmune disease** characterized by **dry eyes** and **dry mouth**, resulting from immune-mediated destruction of exocrine glands [1]. - While it can involve multiple organ systems and is classified as a **systemic autoimmune disorder**, it is primarily an **exocrinopathy**, and not exclusively a disorder of connective tissue structure or function. *Osteoarthritis* - Osteoarthritis is a **degenerative joint disease** primarily affecting the **articular cartilage** and underlying bone. - While it involves destruction of cartilage, which is a connective tissue, it is considered a **degenerative rather than a systemic inflammatory or autoimmune connective tissue disorder**. *Fibromyalgia* - Fibromyalgia is a chronic pain condition characterized by **widespread musculoskeletal pain**, fatigue, and sleep disturbances, without evidence of inflammation or tissue damage [3]. - It is considered a **central sensitization syndrome** rather than a disorder of the connective tissue itself [3]. *SLE* - Systemic lupus erythematosus (SLE) is a **prototypical systemic autoimmune connective tissue disorder** affecting multiple organ systems [2]. - It is characterized by **autoantibody production** and immune complex deposition, leading to inflammation and damage in joints, skin, kidneys, and other tissues [2].

Question 749: Antibodies most specific for drug induced lupus are -

A. ANA
B. Anti Sm
C. Antihistone (Correct Answer)
D. Anti ds DNA

Explanation: ***Antihistone*** - **Antihistone antibodies** are present in 95% of patients with **drug-induced lupus erythematosus (DILE)**, making them the most specific marker for this condition. - The disease often resolves upon discontinuation of the culprit drug, and antihistone antibody levels typically decrease. *ANA* - **Antinuclear antibodies (ANA)** are present in nearly all forms of lupus, including DILE, but are **not specific** for drug-induced forms as they are also found in SLE and other autoimmune diseases [1]. - A positive ANA test is often the initial screening test for lupus but requires further, more specific antibody testing for differentiation. *Anti Sm* - **Anti-Smith (Anti-Sm) antibodies** are highly specific for **systemic lupus erythematosus (SLE)** [1], but are rarely seen in DILE. - Their presence strongly suggests a diagnosis of SLE and not drug-induced lupus. *Anti ds DNA* - **Anti-double-stranded DNA (Anti-dsDNA) antibodies** are highly specific for **systemic lupus erythematosus (SLE)** and are often associated with disease activity and **lupus nephritis**. - These antibodies are typically **absent** or present in very low titers in DILE, differentiating it from SLE.

Question 750: Most common manifestation of rheumatic fever –

A. Chorea
B. Carditis
C. Arthritis (Correct Answer)
D. Nodules

Explanation: ***Arthritis*** - **Polyarthritis** is the most common major manifestation of acute rheumatic fever (ARF), affecting up to 75% of patients. - It typically presents as a **migratory arthritis** affecting large joints such as knees, ankles, elbows, and wrists, resolving without sequelae. *Chorea* - **Sydenham's chorea** (St. Vitus' dance) is a neurological manifestation characterized by sudden, involuntary, jerky movements, occurring in about 10-30% of ARF cases. - While a major criterion, its incidence is significantly lower than that of arthritis. *Carditis* - **Carditis** is the most serious manifestation of ARF, affecting 40-70% of patients and often leading to chronic rheumatic heart disease. - Although it has the highest mortality and morbidity, its frequency is less than that of arthritis. *Nodules* - **Subcutaneous nodules** are rare manifestations of ARF, typically appearing on extensor surfaces of joints or the spine, and are usually painless. - They occur in less than 1-2% of cases, making them one of the least common major criteria.

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

Want unlimited practice?

Get full access to all questions, explanations, and performance tracking.

Start For Free