Rheumatology and Immunology Practice Questions

Q: What is the primary condition associated with atrophic changes in the mucous membranes?

Sjogren's syndrome. ***Sjogren's syndrome*** - It is an **autoimmune disease** primarily characterized by the destruction of exocrine glands, leading to **dryness of mucous membranes** (xerostomia, xerophthalmia) [1]. - The chronic inflammation and lymphocytic infiltration of glands result in **atrophy and dysfunction**, particularly of the salivary and lacrimal glands. *Lupus erythematosus* - While it is an autoimmune disease that can affect multiple organs, its primary manifestation is not typically **atrophic changes in mucous membranes**. [1] - **Oral ulcers** and **photosensitivity** are common, but widespread glandular atrophy is not characteristic [2]. *Celiac disease* - This is an **autoimmune disorder** primarily affecting the **small intestine** due to gluten ingestion, leading to **villous atrophy**. - While it can cause some oral manifestations (e.g., aphthous ulcers), it does not directly cause widespread atrophy of mucous membranes in other parts of the body. *Vitamin B12 deficiency* - Can cause **glossitis** (inflammation of the tongue), which might appear smooth and atrophic due to the loss of papillae. - However, it does not typically lead to systemic atrophy of mucous membranes beyond specific areas like the tongue or a general dryness.

Q: Juvenile idiopathic arthritis includes all the following categories except:

Reactive arthritis. ***Reactive arthritis*** - **Reactive arthritis** is not a subtype of Juvenile Idiopathic Arthritis (JIA); instead, it is a **spondyloarthritis** that typically develops after an infection. - While it can occur in children, its pathogenesis and diagnostic criteria differentiate it from the various JIA categories. *Psoriatic arthritis* - **Psoriatic arthritis** is indeed a recognized category of JIA, characterized by arthritis accompanied by psoriasis or a family history of psoriasis. - It often presents with **dactylitis** (sausage digits) and nail changes in addition to joint involvement. *Enthesitis related arthritis* - **Enthesitis-related arthritis** is a JIA subtype primarily affecting the **entheses** (sites where tendons or ligaments attach to bone) and often the axial skeleton. - It is frequently associated with **HLA-B27 positivity** and occurs more commonly in boys. *Systemic arthritis* - **Systemic arthritis** (formerly Still's disease) is a distinct JIA category characterized by **daily fevers**, skin rash, and internal organ involvement such as hepatosplenomegaly, lymphadenopathy, and serositis. - Arthritis may develop later in the disease course or be less prominent initially compared to systemic symptoms.

Q: Which of the following is a feature of rheumatoid arthritis?

Symmetric joint involvement with erosive changes. ***Symmetric joint involvement with erosive changes*** - **Rheumatoid arthritis** is characterized by **symmetric polyarthritis**, meaning it affects the same joints on both sides of the body [1]. - The chronic inflammation leads to the destruction of cartilage and bone, resulting in **erosive changes** visible on radiographs [1]. *Heberden nodes* - **Heberden nodes** are characteristic bony enlargements of the **distal interphalangeal (DIP) joints**, typically seen in **osteoarthritis** [1]. - They are not a feature of **rheumatoid arthritis**, which primarily affects the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints [1]. *Swan neck deformity* - **Swan neck deformity** is a classic hand deformity seen in **rheumatoid arthritis**, characterized by hyperextension of the PIP joint and flexion of the DIP joint. - While it is a feature of chronic rheumatoid arthritis, it represents an advanced stage of the disease and is not a defining characteristic of the initial presentation of RA. *Ulnar deviation of fingers at metacarpophalangeal joint* - **Ulnar deviation** is a common deformity in **rheumatoid arthritis**, where the fingers drift towards the ulnar side at the **metacarpophalangeal (MCP) joints**. - This is a clinical manifestation of the disease, but **symmetric joint involvement with erosive changes** is a more fundamental and diagnostic feature.

Q: What is the drug of choice for the treatment of acute gout in patients in whom NSAIDs are contraindicated?

Colchicine. ***Colchicine*** * **Colchicine** is a highly effective anti-inflammatory agent for acute gout flares, particularly when initiated early in the attack. * It is often the drug of choice when **NSAIDs are contraindicated** due to renal, gastrointestinal, or cardiovascular issues. *Allopurinol* * **Allopurinol** is a **xanthine oxidase inhibitor** used for long-term **gout prophylaxis** by reducing uric acid levels, not for acute attacks. * Initiating allopurinol during an acute flare can sometimes *exacerbate* the attack by transiently shifting uric acid levels. *Febuxostat* * **Febuxostat** is another **xanthine oxidase inhibitor** used for **chronic management of hyperuricemia** in gout patients, similar to allopurinol. * It is not indicated for the **acute treatment of gout** due to its mechanism of action, which focuses on reducing uric acid production over time. *Paracetamol* * **Paracetamol (acetaminophen)** is an **analgesic** and **antipyretic** but possesses very limited anti-inflammatory properties. * It is generally **ineffective** for the intense inflammatory pain and swelling characteristic of an acute gout attack.

Q: Which of the following statements about systemic sclerosis is correct?

Has a genetic predisposition component. ***Has a genetic predisposition component*** - While not a simple Mendelian disorder, **systemic sclerosis** is known to have a **genetic predisposition**, with certain **HLA alleles** and other genes increasing susceptibility. - This genetic component interacts with environmental factors to trigger the disease in susceptible individuals. *Always leads to pulmonary arterial hypertension* - While **pulmonary arterial hypertension (PAH)** is a serious complication of systemic sclerosis, it does not occur in **all patients**; its prevalence varies depending on the disease subtype. - A significant percentage of patients, particularly those with the **limited cutaneous form**, can develop PAH, but it is not a 100% certainty. *Is always associated with anticentromere antibodies* - **Anticentromere antibodies (ACA)** are commonly found in patients with the **limited cutaneous form of systemic sclerosis** (CREST syndrome) but are not present in all patients. - Patients with the **diffuse cutaneous form** often test positive for **anti-Scl-70 (topoisomerase I) antibodies** or other autoantibodies. *Is characterized by calcinosis cutis in all patients* - **Calcinosis cutis**, the deposition of calcium salts in the skin, is a component of CREST syndrome (part of limited systemic sclerosis) but is **not present in all patients** with systemic sclerosis [1]. - Its presence varies, and it is more characteristic of the limited form rather than the diffuse form of the disease [1].

Q: Which of the following conditions is not associated with antiphospholipid syndrome?

Thrombocytosis. ***Thrombocytosis*** - **Antiphospholipid syndrome (APS)** is characterized by increased **thrombosis** (clotting), not an increase in platelet count (thrombocytosis). - Patients with APS may experience **thrombocytopenia** (low platelet count), which is distinct from thrombocytosis [1]. *Venous thrombosis* - **Venous thrombosis**, particularly deep vein thrombosis (DVT) and pulmonary embolism (PE), is a hallmark feature of APS [2]. - The presence of **antiphospholipid antibodies** promotes a procoagulant state, leading to clot formation in veins. *Recurrent foetal loss* - **Recurrent foetal loss**, including miscarriages and stillbirths, is a classic obstetric manifestation of APS. - The antibodies interfere with placental function and blood supply, leading to pregnancy complications. *Neurological manifestations* - Various **neurological manifestations** are associated with APS, including stroke, transient ischemic attacks (TIAs), and cognitive dysfunction. - These are often due to **microthrombosis** in the cerebral vasculature or direct antibody effects.

Q: Which of the following diseases is not a common cause of vasculitis in adults?

Kawasaki disease. ***Kawasaki diseases*** - Typically affects **children** rather than adults, making it an uncommon cause of vasculitis in the adult population [1]. - Characterized by **fever**, **rash**, and **cardiac complications**, but seldom seen in adults. *Poly arteritis nodosa* - A serious type of **vasculitis** affecting medium-sized arteries, commonly seen in adults [1]. - It can lead to complications such as **renal failure** and **intestinal ischemia**. *Giant cell arthritis* - Also known as **temporal arteritis**, it is a common vasculitis in adults that often presents with **headaches** and **jaw claudication**. - Associated with **polymyalgia rheumatica**, indicating vascular inflammation primarily in older adults. *Henoch-Schönlein purpura* - More common in **children**, but may occur in adults; it presents with **purpura**, **arthralgia**, and **abdominal pain** [2]. - Though less frequent, it is still occasionally considered in the differential diagnosis of adult vasculitis.

Q: Which of the following is the difference between rheumatoid arthritis and osteoarthritis?

Systemic symptoms are seen in rheumatoid arthritis. The original Explanation **Systemic symptoms are seen in rheumatoid arthritis** * **Rheumatoid arthritis** is a **systemic autoimmune disease** that can affect various organs beyond the joints, leading to symptoms like **fatigue**, **fever**, weight loss, and **rheumatoid nodules** [1]. * **Osteoarthritis** is a localized joint disease primarily affecting the cartilage and bone, and it typically **does not cause systemic symptoms** [1]. *Osteophytes are seen in osteoarthritis* * While **osteophytes** (bone spurs) are characteristic of **osteoarthritis**, their presence alone does not differentiate it from rheumatoid arthritis, as other conditions can also feature these [1]. * The primary differentiator lies in the underlying **pathophysiology** (degenerative vs. inflammatory) and the presence of systemic manifestations [1]. *Rheumatoid arthritis is common in hands and feet* * It is true that **rheumatoid arthritis** commonly affects the **small joints of the hands and feet**, often in a **symmetrical pattern** [1]. * However, this statement describes a common site of involvement rather than a fundamental difference in the **nature of the disease** or its systemic impact. *Osteoarthritis is not an autoimmune disease* * This statement is correct; **osteoarthritis is not an autoimmune disease**, but rather a **degenerative joint disease**. * While true, it describes what osteoarthritis **is not**, rather than a defining clinical difference in presentation or systemic involvement compared to rheumatoid arthritis.

Q: In which of the following conditions are Anti-TNF agents contraindicated?

RA with Hepatitis B. ***RA with Hepatitis B*** - **Anti-TNF agents** can cause reactivation of **latent Hepatitis B virus (HBV)** infection, leading to severe hepatitis and liver failure [1]. Therefore, screening for HBV is crucial before initiating these medications [1]. - Patients with active or chronic HBV infection often require **antiviral therapy** before or concurrently with anti-TNF treatment to prevent reactivation. *RA with HIV* - While caution is advised, **anti-TNF agents** can be used in patients with **well-controlled HIV infection** on antiretroviral therapy, often with close monitoring for infections. - The risk of opportunistic infections is carefully balanced against the benefits of controlling rheumatoid arthritis and preventing joint damage [1]. *RA with HCV* - **Anti-TNF agents** are generally considered safe for patients with **Hepatitis C virus (HCV)** infection, especially if the HCV is stable or being treated. - There is no strong evidence to suggest that anti-TNF therapy commonly causes HCV reactivation or worsening of liver disease. *RA with pulmonary fibrosis* - The use of **anti-TNF agents** in patients with established **pulmonary fibrosis** is generally not contraindicated, though careful monitoring for worsening respiratory symptoms is important. - Some anti-TNF agents have been associated with **interstitial lung disease**, but this is typically a new onset condition rather than exacerbation of pre-existing fibrosis.

Question 1

What is the primary condition associated with atrophic changes in the mucous membranes?

Accepted Answer

Sjogren's syndrome

Answer

Lupus erythematosus

Answer

Celiac disease

Answer

Vitamin B12 deficiency

Question 2

Juvenile idiopathic arthritis includes all the following categories except:

Accepted Answer

Reactive arthritis

Answer

Psoriatic arthritis

Answer

Enthesitis related arthritis

Answer

Systemic arthritis

Question 3

What are the common complications associated with hypogammaglobulinemia?

Accepted Answer

Chronic recurrent sinusitis due to impaired antibody production

Answer

Nosebleeds due to vascular issues

Answer

Muscle contractures unrelated to immune function

Answer

Eczema as a result of immune dysregulation

Question 4

Which of the following is a feature of rheumatoid arthritis?

Accepted Answer

Symmetric joint involvement with erosive changes

Answer

Swan neck deformity

Answer

Heberden nodes

Answer

Ulnar deviation of fingers at metacarpophalangeal joint

Question 5

What is the drug of choice for the treatment of acute gout in patients in whom NSAIDs are contraindicated?

Accepted Answer

Colchicine

Answer

Allopurinol

Answer

Paracetamol

Answer

Febuxostat

Question 6

Which of the following statements about systemic sclerosis is correct?

Accepted Answer

Has a genetic predisposition component

Answer

Always leads to pulmonary arterial hypertension

Answer

Is always associated with anticentromere antibodies

Answer

Is characterized by calcinosis cutis in all patients

Question 7

Which of the following conditions is not associated with antiphospholipid syndrome?

Accepted Answer

Thrombocytosis

Answer

Venous thrombosis

Answer

Neurological manifestations

Answer

Recurrent foetal loss

Question 8

Which of the following diseases is not a common cause of vasculitis in adults?

Accepted Answer

Kawasaki disease

Answer

Giant cell arteritis

Answer

Polyarteritis nodosa

Answer

Henoch-Schönlein purpura

Question 9

Which of the following is the difference between rheumatoid arthritis and osteoarthritis?

Accepted Answer

Systemic symptoms are seen in rheumatoid arthritis

Answer

Osteophytes are seen in osteoarthritis

Answer

Rheumatoid arthritis is common in hands and feet

Answer

Osteoarthritis is not an autoimmune disease

Question 10

In which of the following conditions are Anti-TNF agents contraindicated?

Accepted Answer

RA with Hepatitis B

Answer

RA with HCV

Answer

RA with pulmonary fibrosis

Answer

RA with HIV

Rheumatology and Immunology — MCQs

Rheumatology and Immunology — MCQs

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