Rheumatology and Immunology Practice Questions

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

Temporal arteritis. ***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.

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

Anti-centromere antibodies. ***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.

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

Polymyositis. 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.

Q: Takayasu arteritis mainly affects?

Subclavian artery. ***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.

Q: In which condition is salivary scintigraphy particularly useful?

Sjogren syndrome. ***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.

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

Skin. ***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.

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

Type V. ***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.

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

Muscle. ***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.

Q: Which joint is most commonly affected in pseudogout?

Knee. ***Knee*** - The **knee joint** is the most frequent site of acute attacks and chronic arthropathy in pseudogout due to the propensity for **calcium pyrophosphate dihydrate (CPPD)** crystal deposition in larger joints [1]. - Patients often present with acute, painful, and swollen knees, sometimes mimicking septic arthritis or gout [1]. *Hip* - While hip involvement can occur in pseudogout, it is **less common** than knee involvement and often manifests as chronic degenerative changes. - Acute hip flares are rarer compared to the knee. *MP joint great toe* - The **metatarsaophalangeal (MTP) joint of the great toe** is the classic site for **gout**, caused by monosodium urate crystal deposition. - Although pseudogout can affect various joints, this specific location is strongly indicative of gout, not pseudogout. *MP joint thumb* - The **metacarpophalangeal (MCP) joint of the thumb** can be affected in various arthropathies, but it is not the most commonly affected joint in pseudogout. - Involvement here is less specific for pseudogout compared to the knee.

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

Polyarthalgia. ***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 1

Which condition is characterized by a Type 4 hypersensitivity reaction?

Accepted Answer

Temporal arteritis

Answer

Asthma

Answer

Serum sickness

Answer

Myasthenia gravis

Question 2

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

Accepted Answer

Anti-centromere antibodies

Answer

Anti-DNA topoisomerase I

Answer

Anti-double-stranded DNA antibodies

Answer

Anti-Golgi antibodies

Question 3

Anti Jo-1 antibodies are a feature associated with?

Accepted Answer

Polymyositis

Answer

Systemic sclerosis (scleroderma)

Answer

Rheumatoid arthritis (RA)

Answer

Systemic lupus erythematosus (SLE)

Question 4

Takayasu arteritis mainly affects?

Accepted Answer

Subclavian artery

Answer

Pulmonary artery

Answer

Celiac artery

Answer

Aorta

Question 5

In which condition is salivary scintigraphy particularly useful?

Accepted Answer

Sjogren syndrome

Answer

Salivary gland tumors

Answer

Sialolithiasis

Answer

Acute sialadenitis

Question 6

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

Accepted Answer

Skin

Answer

Bone marrow

Answer

Liver

Answer

Gut

Question 7

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

Accepted Answer

Type V

Answer

Type III

Answer

Type IV

Answer

Type I

Question 8

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

Accepted Answer

Muscle

Answer

Helix of ear

Answer

Prepatellar bursae

Answer

Synovial membrane

Question 9

Which joint is most commonly affected in pseudogout?

Accepted Answer

Knee

Answer

Hip

Answer

MP joint great toe

Answer

MP joint thumb

Question 10

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

Accepted Answer

Polyarthalgia

Answer

Erythema marginatum

Answer

Carditis

Answer

Chorea

Rheumatology and Immunology — MCQs

Rheumatology and Immunology — MCQs

On this page

Practice by Chapter

Want unlimited practice?