Rheumatology and Immunology — MCQs

Rheumatology and Immunology Indian Medical PG Practice Questions and MCQs

Question 761: Sicca syndrome is associated with all except?

A. Chronic active hepatitis
B. Midline granuloma (Correct Answer)
C. Rheumatoid arthritis
D. Scleroderma

Explanation: Sicca syndrome is associated with all except? ***Midline granuloma*** - **Midline granuloma** (now commonly referred to as **extranodal NK/T-cell lymphoma, nasal type**) is a destructive inflammatory process primarily affecting the upper respiratory tract. It is not directly associated with the autoimmune features of sicca syndrome. - Its pathology involves an aggressive **lymphoproliferative disorder**, distinct from the glandular dysfunction seen in sicca syndrome. *Chronic active hepatitis* - **Primary biliary cholangitis** (formerly primary biliary cirrhosis), a form of chronic active hepatitis, is strongly associated with sicca syndrome. Patients often experience dry eyes and mouth alongside liver involvement. - Autoimmune hepatitis can also present with **extraglandular manifestations** including sicca symptoms, highlighting a systemic autoimmune link. *Rheumatoid arthritis* - **Secondary Sjögren's syndrome**, which manifests as sicca symptoms, commonly occurs in patients with **rheumatoid arthritis (RA)**. This is a well-recognized overlap. - The inflammatory processes common to both conditions suggest a shared **autoimmune pathogenesis**. *Scleroderma* - **Systemic sclerosis (scleroderma)** is another autoimmune connective tissue disease that frequently overlaps with Sjögren's syndrome and features of sicca [1]. - Patients with scleroderma often report **dry eyes and mouth**, reflecting autoimmune involvement of the exocrine glands.

Question 762: Which is the best investigation to confirm diagnosis of anaphylaxis?

A. IgA levels
B. Serum tryptase (Correct Answer)
C. IgD levels
D. Serum precipitins

Explanation: ***Serum tryptase*** - **Serum tryptase** is released from activated mast cells and is a reliable biomarker for confirming anaphylaxis, particularly when measured within 1-3 hours of symptom onset. - Elevated levels help differentiate anaphylaxis from other conditions with similar symptoms, especially when the clinical picture is ambiguous. *IgA levels* - **IgA levels** are relevant in diagnosing conditions like selective IgA deficiency or celiac disease, but they do not play a direct role in confirming acute anaphylaxis. - They reflect long-term immune status rather than immediate hypersensitivity reactions. *IgD levels* - **IgD levels** have no established role in the diagnosis or confirmation of anaphylaxis. - Their physiological function is not fully understood, but they are not used as biomarkers for acute allergic reactions. *Serum precipitins* - **Serum precipitins** are antibodies detected in various hypersensitivity reactions, especially to inhaled antigens, and are not specific for anaphylaxis [1]. - They are primarily associated with conditions like hypersensitivity pneumonitis, reflecting different immunological mechanisms [1].

Question 763: Raynaud's phenomenon seen in all EXCEPT:

A. Scleroderma
B. SLE
C. Juvenile rheumatoid arthritis (Correct Answer)
D. Dermatomyositis

Explanation: ***Juvenile rheumatoid arthritis*** - While other **rheumatic conditions** are often associated with Raynaud's phenomenon, **juvenile idiopathic arthritis (JIA)**, including the category once known as **juvenile rheumatoid arthritis**, is generally not a common cause [2]. - Its pathophysiology primarily involves **joint inflammation** rather than **vasospastic disorders**. *Scleroderma* - Raynaud's phenomenon is a **hallmark symptom** in nearly all patients with **scleroderma**, often preceding other symptoms by years [3]. - It results from **fibrosis and structural changes** in small blood vessels, leading to exaggerated vasoconstriction [3]. *SLE* - **Systemic lupus erythematosus (SLE)** is frequently associated with Raynaud's phenomenon, occurring in about 20-30% of patients [1]. - It is part of the broader **vasculopathy** seen in autoimmune diseases. *Dermatomyositis* - Raynaud's phenomenon can occur in patients with **dermatomyositis**, though less frequently than in scleroderma (around 15-20%). - Its presence often indicates a more complex **autoimmune overlap syndrome**.

Question 764: HLA B27 is associated with all except: a) Ankylosing spondylitis b) Pernicious anemia c) Behcet's syndrome d) Reiter's syndrome

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

Explanation: ***Behcet's syndrome*** - While Behcet's syndrome is an inflammatory condition, it is **not typically associated with HLA-B27**. It is more commonly linked to **HLA-B51**. - Its clinical presentation involves recurrent oral and genital ulcers, uveitis, and skin lesions, which are distinct from the spondyloarthritis spectrum. *Ankylosing spondylitis* - This is a classic **HLA-B27 associated spondyloarthropathy**, characterized by chronic inflammation of the sacroiliac joints and spine [1]. - The presence of HLA-B27 significantly increases susceptibility to this condition. *Reiter's syndrome* - Now more commonly referred to as **Reactive Arthritis**, this condition is strongly associated with **HLA-B27** [1]. - It often presents with a triad of arthritis, urethritis, and conjunctivitis following a genitourinary or gastrointestinal infection. *Psoriatic arthritis* - While not as strongly linked as ankylosing spondylitis or reactive arthritis, about **30-50% of patients with psoriatic arthritis test positive for HLA-B27**, especially those with spinal involvement [1]. - It is an inflammatory arthritis associated with **psoriasis** and can affect peripheral joints, the spine, and entheses.

Question 765: Which is a minor criterion for diagnosis of RF according to modified Jones criteria?

A. Past History of Rheumatic Fever
B. Fever (Correct Answer)
C. Subcutaneous nodules
D. ASO titre

Explanation: ***

Question 766: "Telescope fingers" occur in

A. Reiter's arthritis
B. Rheumatic fever
C. Psoriatic arthritis (Correct Answer)
D. Rheumatoid arthritis

Explanation: ### Psoriatic arthritis - **Telescoping fingers**, also known as **arthritis mutilans**, is a severe and rare form of psoriatic arthritis where bone resorption leads to shortening and collapse of digits [1]. - This extreme joint erosion and destruction result in the characteristic "opera glass" or "telescopic" appearance of the fingers and toes [1]. *Reiter's arthritis* - Reiter's arthritis, now known as **reactive arthritis**, is characterized by the triad of **urethritis**, **arthritis**, and **conjunctivitis**. - While it can cause dactylitis ("sausage digits"), it does not typically lead to the severe bone resorption and telescoping seen in arthritis mutilans. *Rheumatic fever* - **Rheumatic fever** is an inflammatory disease that can develop after a Group A Streptococcus infection, primarily affecting the heart, joints, brain, and skin. - It causes a **migratory polyarthritis** that is typically acute and self-limiting, without permanent joint damage or deformities like telescoping fingers. *Rheumatoid arthritis* - **Rheumatoid arthritis** is a chronic inflammatory autoimmune disease primarily affecting the synovial lining of joints, leading to painful swelling, bone erosion, and joint deformity. - While it can cause severe joint destruction and deformities like **swan-neck** and **boutonnière** deformities, true "telescoping fingers" (arthritis mutilans) are not characteristic of rheumatoid arthritis.

Question 767: An elderly male presents with pain in his shoulders and hands. ESR is 105 mm/L. History includes transient blindness and unilateral headache.

A. Polyarteritis nodosa
B. Polymyalgia rheumatica (Correct Answer)
C. Ankylosing spondylitis
D. Behçet syndrome

Explanation: ***Polymyalgia rheumatica*** - The combination of **shoulder and hand pain** in an elderly male, along with a **very high ESR**, is highly suggestive of polymyalgia rheumatica [1]. - **Sudden transient blindness** and **unilateral headache** are concerning for giant cell arteritis, which is often associated with polymyalgia rheumatica and requires prompt treatment. *Polyarteritis nodosa* - This is a **necrotizing vasculitis** of medium-sized arteries, often presenting with systemic symptoms, **renal involvement**, and **neuropathy**. - It typically does not cause shoulder and hand pain as the primary presenting symptom, and the transient blindness and headache are more characteristic of giant cell arteritis. *Ankylosing spondylitis* - This condition primarily affects the **axial skeleton**, causing **inflammatory back pain** and stiffness, particularly in younger individuals [2]. - It does not typically present with shoulder and hand pain, transient blindness, or a temporal headache in an elderly patient. *Behçet syndrome* - Characterized by **recurrent oral and genital ulcers**, **uveitis**, and **skin lesions**. - The presenting symptoms of shoulder and hand pain, high ESR, transient blindness, and unilateral headache are not typical features of Behçet syndrome.

Question 768: Which of the following is a 'Small Vessel Vasculitis':

A. Takayasu's Disease
B. Polyaeritis Nodosa (PAN)
C. Microscopic polyangitis (Correct Answer)
D. Giant cell vasculitis

Explanation: ***Microscopic polyangitis*** - This is a form of **ANCA-associated vasculitis** that primarily affects **small vessels** (capillaries, venules, and arterioles) [1]. - It is characterized by **necrotizing vasculitis** within these small vessels, often presenting with features like **glomerulonephritis** and **pulmonary hemorrhage** [1]. *Takayasu's Disease* - This is a **large vessel vasculitis** that primarily affects the **aorta** and its major branches [1]. - It often presents with symptoms related to **ischemia** in the upper limbs or head, such as claudication or syncope. *Polyaeritis Nodosa (PAN)* - This is a **medium-sized vessel vasculitis** that typically spares capillaries, venules, and arterioles, distinguishing it from small vessel vasculitis [1]. - It classically presents as a **necrotizing vasculitis** affecting multiple organs, often without affecting the lungs or glomeruli significantly. *Giant cell vasculitis* - Also known as **Temporal Arteritis**, this is a **large vessel vasculitis** affecting the aorta and its major branches, particularly the branches of the **carotid artery** [1]. - It is characterized by the presence of **giant cells** in the inflamed vessel wall and is a common cause of **headache**, **jaw claudication**, and **vision loss** in older adults.

Question 769: All of the following are found in SLE except

A. Psychosis
B. Discoid rash
C. Oral ulcers
D. Leucocytosis (Correct Answer)

Explanation: ***Leucocytosis*** - **Leucopenia** (decreased white blood cell count) is a common hematological manifestation in SLE, not **leucocytosis**. - A persistent white blood cell count of **less than 4,000/mm³** on two or more occasions in the absence of other causes is a criterion for SLE. *Psychosis* - **Neuropsychiatric manifestations**, including psychosis, are recognized as a serious complication of SLE, categorized under **neuropsychiatric SLE (NPSLE)**. - These symptoms result from **inflammation, autoantibody production**, and other immune-mediated processes affecting the central nervous system [1]. *Oral ulcers* - **Oral or nasopharyngeal ulcers** are a common mucocutaneous manifestation of SLE. - These ulcers are typically **painless** and can be found on the **hard palate** or buccal mucosa. *Discoid rash* - A **discoid rash** is a specific skin manifestation of cutaneous lupus, often chronic and causing scarring [1]. - It presents as **erythematous raised patches with adherent keratotic scaling** and follicular plugging, which can lead to scarring alopecia [1].

Question 770: Antibody in drug induced Lupus

A. Anti-Histone (Correct Answer)
B. Anti-smith
C. Anti-phospholipid
D. Anti-Ribosomal

Explanation: ***Anti-Histone*** - **Anti-histone antibodies** are present in 95% of patients with **drug-induced lupus erythematosus (DILE)**, making them the most characteristic serological marker. - They target nuclear proteins (histones) and are crucial for diagnosing DILE. *Anti-smith* - **Anti-Smith antibodies** are highly specific for **systemic lupus erythematosus (SLE)** [1], but not typically associated with drug-induced forms. - Their presence helps distinguish SLE from other autoimmune conditions and drug-induced reactions [1]. *Anti-phospholipid* - **Anti-phospholipid antibodies** are associated with **Antiphospholipid Syndrome (APS)**, an autoimmune disorder causing thrombosis and recurrent pregnancy loss [1]. - While they can be found in a minority of SLE patients, they are not specific to DILE [1]. *Anti-Ribosomal* - **Anti-ribosomal P antibodies** are often found in patients with **SLE**, particularly those with associated **neuropsychiatric symptoms** or **renal involvement**. - They are not a hallmark of drug-induced lupus and are more indicative of idiopathic 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

Practice Questions

Sjögren's Syndrome

Practice Questions

Antiphospholipid Syndrome

Practice Questions

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