Rheumatology and Immunology — MCQs

Rheumatology and Immunology Indian Medical PG Practice Questions and MCQs

Question 871: The most common organ to be involved in the acute phase of Graft vs host disease is?

A. Bone marrow
B. Skin (Correct Answer)
C. Liver
D. Gut

Explanation: ***Skin*** - The **skin** is the **most frequently affected organ** in acute graft-versus-host disease (GVHD), with nearly all patients exhibiting some dermatologic manifestations. - Initial symptoms often include a **maculopapular rash** that can progress to erythroderma or bullous lesions. *Bone marrow* - While the bone marrow is the site of the **allogeneic stem cell transplant**, it is not typically considered an **acute target organ** for GVHD symptoms in the same way as the skin, gut, or liver. - Although the donor immune cells originate here, the manifestations of GVHD primarily affect other host tissues. *Liver* - The **liver** is a common organ involved in acute GVHD, often presenting with **elevated bilirubin** and alkaline phosphatase levels. - However, **liver involvement is less common** than skin involvement and typically occurs alongside or after skin manifestations. *Gut* - The **gastrointestinal tract** (gut) is frequently affected in acute GVHD, leading to symptoms like **diarrhea, nausea, vomiting**, and abdominal pain. - Similar to liver involvement, gut involvement is common but **occurs less frequently than skin involvement** as the primary acute manifestation.

Question 872: In patients with the limited cutaneous form of CREST syndrome, which autoantibody is most commonly found?

A. Anti-centromere antibodies (Correct Answer)
B. Anti-DNA topoisomerase I
C. Anti-double-stranded DNA antibodies
D. Anti-Golgi antibodies

Explanation: ***Anti-centromere antibodies*** - **Anti-centromere antibodies (ACA)** are highly specific for the **limited cutaneous systemic sclerosis (lcSSc)**, often referred to as CREST syndrome. - They are associated with a milder course of the disease and a lower risk of serious internal organ involvement, especially **pulmonary fibrosis**. *Anti-DNA topoisomerase I* - **Anti-DNA topoisomerase I (Scl-70 antibodies)** are classically associated with the **diffuse cutaneous systemic sclerosis (dcSSc)**. - Patients with Scl-70 antibodies are at higher risk for **interstitial lung disease** and more generalized skin involvement. *Anti-double-stranded DNA antibodies* - **Anti-double-stranded DNA (anti-dsDNA) antibodies** are a hallmark of **systemic lupus erythematosus (SLE)**, not systemic sclerosis [1]. - Their presence often correlates with **lupus nephritis** and disease activity in SLE [1]. *Anti-Golgi antibodies* - **Anti-Golgi antibodies** are less commonly tested and are not specifically associated with systemic sclerosis or CREST syndrome. - They are sometimes found in various **autoimmune liver diseases** or in patients with certain neurological conditions.

Question 873: In which condition is salivary scintigraphy particularly useful?

A. Salivary gland tumors
B. Sialolithiasis
C. Sjogren syndrome (Correct Answer)
D. Acute sialadenitis

Explanation: ***Sjogren syndrome*** - Salivary scintigraphy is highly useful in diagnosing **Sjogren syndrome** by assessing **salivary gland function**, specifically the uptake and excretion of the radiotracer. - In Sjogren syndrome, there is **reduced uptake** and **delayed excretion** of the tracer, reflecting the **exocrine gland dysfunction** characteristic of the autoimmune disease [1]. *Salivary gland tumors* - While salivary scintigraphy can sometimes show **"cold" or "hot" spots** corresponding to tumors, its primary role in tumor diagnosis is **limited**. - **MRI** and **CT scans**, along with **fine-needle aspiration biopsy**, are generally **more definitive** for characterizing salivary gland tumors. *Sialolithiasis* - **Sialolithiasis**, or salivary gland stones, is best diagnosed with **plain radiographs**, **ultrasound**, or **CT scans** which can directly visualize the calcifications within the ducts. - Salivary scintigraphy may show **obstruction** but does not directly identify the stone, making it **less specific** for this condition. *Acute sialadenitis* - **Acute sialadenitis** is typically diagnosed clinically based on **pain**, **swelling**, and **tenderness** of the salivary gland, often with purulent discharge from the duct. - Imaging like **ultrasound** or **CT** can help demonstrate inflammation or abscess formation, but scintigraphy is **not a primary diagnostic tool** for acute infection.

Question 874: Which condition is characterized by a Type 4 hypersensitivity reaction?

A. Temporal arteritis (Correct Answer)
B. Asthma
C. Serum sickness
D. Myasthenia gravis

Explanation: ***Temporal arteritis*** - This condition is also known as **giant cell arteritis** and is a classic example of a **Type 4 hypersensitivity reaction**, characterized by **T-cell mediated inflammation** of medium to large arteries [1]. - The inflammatory response is driven by activated **T lymphocytes** and **macrophages** infiltrating the arterial walls, leading to giant cell formation and pathology [1]. *Asthma* - **Asthma** is primarily mediated by a **Type 1 hypersensitivity reaction**, involving IgE antibodies and mast cell degranulation upon exposure to allergens. - This leads to immediate release of inflammatory mediators causing **bronchoconstriction** and airway inflammation. *Serum sickness* - **Serum sickness** is a **Type 3 hypersensitivity reaction**, caused by the formation of **immune complexes** (antigen-antibody complexes) that deposit in tissues and trigger inflammation [1]. - These immune complexes activate complement and recruit inflammatory cells, leading to symptoms like fever, rash, and arthralgia [1]. *Myasthenia gravis* - **Myasthenia gravis** is a **Type 2 hypersensitivity reaction**, where circulating **autoantibodies** target and block or destroy acetylcholine receptors at the neuromuscular junction [1]. - This destruction of receptors impairs nerve-to-muscle signaling, causing muscle weakness.

Question 875: Anti Jo-1 antibodies are a feature associated with?

A. Polymyositis (Correct Answer)
B. Systemic sclerosis (scleroderma)
C. Rheumatoid arthritis (RA)
D. Systemic lupus erythematosus (SLE)

Explanation: Polymyositis - **Anti-Jo-1 antibodies** are a specific type of **anti-synthetase antibody** and are a key serological marker for polymyositis [1]. - Their presence often indicates a more severe form of the disease with a higher likelihood of **interstitial lung disease**, **Raynaud's phenomenon**, and **"mechanic's hands"** [1]. *Systemic sclerosis (scleroderma)* - While systemic sclerosis is also an **autoimmune connective tissue disease**, it is typically associated with antibodies such as **anti-Scl-70** (topoisomerase I) or **anti-centromere antibodies**. - **Anti-Jo-1 antibodies** are not characteristic of systemic sclerosis; their presence would suggest a different or overlapping diagnosis. *Rheumatoid arthritis (RA)* - **Rheumatoid arthritis** is primarily diagnosed by the presence of **rheumatoid factor (RF)** and **anti-cyclic citrullinated peptide (anti-CCP) antibodies**. - **Anti-Jo-1 antibodies** are not found in the typical serological profile of rheumatoid arthritis. *Systemic lupus erythematosus (SLE)* - **Systemic lupus erythematosus** is characterized by a wide array of autoantibodies, most notably **anti-nuclear antibodies (ANA)**, **anti-dsDNA antibodies**, and **anti-Sm antibodies** [2]. - **Anti-Jo-1 antibodies** are rarely, if ever, found in SLE and would point away from this diagnosis.

Question 876: Takayasu arteritis mainly affects?

A. Pulmonary artery
B. Celiac artery
C. Subclavian artery (Correct Answer)
D. Aorta

Explanation: ***Subclavian artery*** - **Takayasu arteritis** is a chronic inflammatory disorder that primarily affects the **aorta** and its **major branches**, including the subclavian arteries [1]. - Inflammation of the subclavian arteries can lead to **stenosis** or **occlusion**, resulting in symptoms such as **arm claudication**, **pulse deficit**, and blood pressure discrepancies between arms. *Pulmonary artery* - While Takayasu arteritis can, in rare cases, affect the pulmonary arteries, it is not their primary or most common target. - **Pulmonary artery involvement** is less frequent and generally seen in more widespread or severe disease. *Celiac artery* - The celiac artery, a branch of the aorta supplying the foregut, can be affected by **Takayasu arteritis**, but it is less commonly involved than the great vessels emanating from the aortic arch. - Involvement here can lead to symptoms like **abdominal pain** or **mesenteric ischemia**. *Aorta* - Takayasu arteritis primarily targets the **aorta** and its **proximal branches**, but "subclavian artery" is a more specific and common site of severe clinical manifestation often associated with the disease [1]. - The aorta itself is frequently affected, leading to **aneurysms**, **stenosis**, or **dilatation** throughout its course.

Question 877: Which of the following is NOT a major criterion in the Modified Jones Criteria for diagnosing Rheumatic Fever?

A. Erythema marginatum
B. Carditis
C. Chorea
D. Polyarthalgia (Correct Answer)

Explanation: ***Polyarthralgia*** - **Polyarthralgia** is a **minor criterion** in the Modified Jones Criteria, indicating joint pain without objective signs of inflammation. - For a criterion to be considered major, it must involve objective signs of arthritis, which differentiate it from mere pain. [1] *Carditis* - **Carditis** is a **major criterion** and refers to inflammation of the heart, which can manifest as pericarditis, myocarditis, or endocarditis, often leading to valvular damage. [1] - It is one of the most serious manifestations of rheumatic fever and can lead to long-term cardiac complications. *Chorea* - **Sydenham chorea** (also known as St. Vitus' dance) is a **major criterion** characterized by involuntary, purposeless movements, primarily affecting the face, hands, and feet. [1] - It is a neurological manifestation reflecting central nervous system involvement and can appear late in the course of the disease. [1] *Erythema marginatum* - **Erythema marginatum** is a **major criterion** presenting as a distinctive, transient, non-pruritic rash with pink or red rings and clear centers, typically appearing on the trunk and proximal extremities. - This rash is a specific skin manifestation of acute rheumatic fever, though it is relatively uncommon.

Question 878: Tophi in gout are typically found in all regions except which of the following?

A. Helix of ear
B. Prepatellar bursae
C. Synovial membrane
D. Muscle (Correct Answer)

Explanation: ***Muscle*** - **Tophi** are crystalline deposits of **monosodium urate** that form in chronic gout [1]. They are typically found in cooler, less vascularized tissues, or tissues subjected to repetitive trauma. - While tophi can occur in many soft tissues, their presence **within muscle tissue is rare**, as muscle is well-vascularized and not a primary site for urate deposition [2]. *Prepatellar bursae* - The **prepatellar bursa** is a common site for tophi due to its superficial location and exposure to trauma. - Inflammation of the prepatellar bursa due to tophi accumulation is known as **"housemaid's knee"**. *Helix of ear* - The **helix of the ear** is a classic location for tophi due to its cooler temperature and poor vascularity, making it an ideal site for urate crystal deposition [1]. - These are often painless, subcutaneous nodules. *Synovial membrane* - The **synovial membrane** lining joints is a very common site for tophi formation, leading to destructive arthritis in chronic gout [2]. - Urate crystals in the synovial fluid provoke acute inflammatory attacks and can accumulate in the membrane over time.

Question 879: What is the most common variant of Takayasu Disease in India?

A. Type III
B. Type V (Correct Answer)
C. Type IV
D. Type I

Explanation: ***Type V*** - **Type V Takayasu arteritis** involves both the **aortic arch and its branches** (similar to Type I or II) AND the **abdominal aorta** and/or **renal arteries** (similar to Type III or IV) [1]. - This extensive involvement is the **most common presentation** of Takayasu arteritis in India, characterized by widespread vasculopathy affecting multiple arterial segments. *Type I* - **Type I Takayasu arteritis** primarily affects the **aortic arch** and its main branches, such as the subclavian, carotid, and vertebral arteries [1]. - While present in India, it is **less common** than Type V, which also includes abdominal aortic involvement. *Type III* - **Type III Takayasu arteritis** involves the **thoracic descending aorta, abdominal aorta**, and/or **renal arteries**, in addition to the **aortic arch branches**. - Although it includes abdominal involvement, it does not encompass the full range of involvement seen in the most prevalent Indian variant, Type V. *Type IV* - **Type IV Takayasu arteritis** is characterized by involvement of the **abdominal aorta** and/or **renal arteries** [1]. - This type is less common as a sole presentation in India; typically, renal artery involvement is part of a more generalized arterial inflammation, as seen in Type V.

Question 880: Arthritis involving DIP, PIP, 1st carpometacarpal with sparing of MCP and wrist joints is typical of ?

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

Explanation: ***Osteoarthritis*** - **Osteoarthritis** characteristically affects the **DIP (Heberden's nodes)**, **PIP (Bouchard's nodes)**, and the **first carpometacarpal joint** at the base of the thumb [1]. - It typically spares the **MCP and wrist joints**, which helps differentiate it from inflammatory arthropathies like rheumatoid arthritis [1], [2]. *Rheumatoid arthritis* - **Rheumatoid arthritis** characteristically affects the **MCP and wrist joints**, sparing the DIP joints [2]. - It presents with **symmetrical polyarthritis** and often includes systemic symptoms [2]. *Ankylosing spondylitis* - **Ankylosing spondylitis** primarily affects the **axial skeleton**, particularly the sacroiliac joints and spine. - While peripheral joint involvement can occur, it's typically in larger joints and not the characteristic DIP/PIP pattern of this case. *Psoriatic arthritis* - **Psoriatic arthritis** can affect the **DIP joints** and can present with patterns similar to osteoarthritis or rheumatoid arthritis [3]. - However, it's strongly associated with **psoriasis** (skin and nail changes) and can involve various other patterns, including **dactylitis** (sausage digits) and enthesitis, which makes it less typical for the described sparing pattern alone [3].

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