Rheumatology and Immunology Practice Questions

Q: Which condition is most likely associated with specific angiographic findings such as the rosary sign?

Polyarteritis Nodosa. ***Polyarteritis Nodosa*** - The **rosary sign** on angiography, characterized by alternating areas of stenosis and dilation in medium-sized arteries, is a classic finding in **Polyarteritis Nodosa (PAN)**. - This sign represents **aneurysms and stenoses** resulting from inflammatory destructive lesions in the arterial wall. *Kawasaki disease* - Primarily affects young children and causes **coronary artery aneurysms**, which appear as focal dilations, rather than the "rosary sign" pattern of multiple stenoses and dilations seen in PAN. - While it can involve other medium-sized arteries, the widespread and characteristic "rosary sign" is not typical. *Takayasu arteritis* - This condition primarily affects the **aorta and its major branches**, leading to **stenosis or occlusion** of large arteries, often described as "pulseless disease." - It does not typically present with the **venous beads-like appearance** or rosary sign found in PAN. *Giant cell arteritis* - Characterized by inflammation of **large and medium-sized arteries**, predominantly affecting the temporal arteries. - Angiographic findings often include **long segments of smooth vessel wall thickening, stenosis, or occlusion**, but not the characteristic alternating aneurysms and stenoses of the "rosary sign."

Q: A 30-year-old female presents with a butterfly rash on her face, photosensitivity, and joint pain, and laboratory tests reveal positive antinuclear antibody (ANA) and anti-double-stranded DNA (anti-dsDNA) antibodies. What is the most likely diagnosis?

Systemic lupus erythematosus. ***Systemic lupus erythematosus*** - The combination of a **butterfly rash**, **photosensitivity**, **arthralgia**, and positive **ANA** and **anti-dsDNA antibodies** is highly characteristic of systemic lupus erythematosus (SLE) [1]. - **Anti-dsDNA antibodies** are very specific for SLE and correlate with disease activity, especially **renal involvement** [1]. *Rheumatoid arthritis* - While it causes **joint pain**, it typically presents with **symmetrical polyarthritis** affecting small joints and lacks the hallmark skin manifestations like a butterfly rash [1]. - Serologically, **rheumatoid arthritis** is associated with **rheumatoid factor (RF)** and **anti-CCP antibodies**, not anti-dsDNA. *Psoriatic arthritis* - This condition is associated with **psoriasis**, manifesting as **scaly skin patches**, and can cause **arthritis**. - It does not typically present with a **butterfly rash** or the specific autoantibodies (ANA, anti-dsDNA) seen in this patient. *Dermatomyositis* - Characterized by **proximal muscle weakness** and distinct skin rashes such as **heliotrope rash** (purplish discoloration around the eyes) and **Gottron's papules** (reddish-purple papules over knuckles). - While it can involve **photosensitivity**, it does not typically present with a **butterfly rash** [1] or **anti-dsDNA antibodies**.

Question 1

Soft tissue calcification around the knee is seen in:

Accepted Answer

Calcium pyrophosphate dihydrate crystal deposition (Pseudogout)

Answer

Vitamin C deficiency (Scurvy)

Answer

Primary hyperparathyroidism

Answer

Systemic sclerosis (Scleroderma)

Question 2

Which condition is most likely associated with specific angiographic findings such as the rosary sign?

Accepted Answer

Polyarteritis Nodosa

Answer

Giant cell arteritis

Answer

Kawasaki disease

Answer

Takayasu arteritis

Question 3

A 30-year-old female presents with a butterfly rash on her face, photosensitivity, and joint pain, and laboratory tests reveal positive antinuclear antibody (ANA) and anti-double-stranded DNA (anti-dsDNA) antibodies. What is the most likely diagnosis?

Accepted Answer

Systemic lupus erythematosus

Answer

Rheumatoid arthritis

Answer

Psoriatic arthritis

Answer

Dermatomyositis

Rheumatology and Immunology — MCQs

Rheumatology and Immunology — MCQs

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