Rheumatology and Immunology Practice Questions

Q: Most common precipitant of Raynaud's phenomenon is

Exposure to cold. ***Exposure to cold*** - **Exposure to cold temperatures**, even mild cold, is the most frequent and characteristic trigger for **vasoconstriction** in Raynaud's phenomenon. - This leads to the classic **triphasic color changes** (white, blue, red) in the digits due to restricted blood flow. *Exposure to heat* - **Exposure to heat** generally causes **vasodilation**, which would alleviate rather than precipitate the symptoms of Raynaud's phenomenon. - While sudden temperature changes can sometimes be a factor, direct heat exposure is not a primary recognized trigger. *Psychosocial triggers* - **Emotional stress** and anxiety can indeed precipitate Raynaud's episodes in some individuals, as the **sympathetic nervous system** plays a role in vasoconstriction. - However, **cold exposure** remains the most common and potent precipitating factor across the majority of cases. *Exertion* - **Physical exertion** typically leads to **vasodilation** in working muscles and increased blood flow to the skin for heat dissipation. - It is not a common or direct precipitant of the localized vasoconstrictive attacks seen in Raynaud's phenomenon.

Q: Which of the following antibodies is highly specific for systemic lupus erythematosus?

Anti-Sm. ***Anti-Sm*** - The **Anti-Sm antibody** is highly specific for **systemic lupus erythematosus (SLE)**, with a specificity of over 99% [1]. - It is often associated with **renal involvement** and more severe disease manifestations [1]. *Anti-Centromere* - Mostly associated with **limited scleroderma**, not SLE, and indicates **creatodermal** changes. - Often found in patients with **Raynaud's phenomenon** and **pulmonary hypertension**, distinct from SLE features. *Anti-U1RNP* - Typically seen in **mixed connective tissue disease (MCTD)**, indicating a combination of features from various autoimmune diseases [1]. - While it can be present in SLE patients, it is not specific to SLE and can be found in other conditions as well. *Anti-RO-1* - Also known as **Anti-SSA**, these antibodies are associated with Sjögren's syndrome, as well as SLE [1]. - They are not specific for SLE as they can appear in other autoimmune diseases, marking their lack of specificity.

Q: Which of the following statements about drug-induced SLE is NOT true?

Female: Male ratio=1:9. ***Female: Male ratio=1:9*** - Drug-induced lupus erythematosus (DILE) typically has no significant **gender predilection**, unlike idiopathic SLE which has a marked female predominance (9:1 female: male ratio) [1]. - This statement is incorrect because the male:female ratio is closer to 1:1, or even male predominance, making the given ratio of 1:9 (female:male) false. *Anti-histone antibodies are negative* - **Anti-histone antibodies** are positive in 95% of patients with drug-induced lupus, making this statement incorrect. - The presence of anti-histone antibodies is a hallmark diagnostic feature of drug-induced lupus. *CNS involvement not common* - **Central nervous system (CNS) manifestations** are indeed uncommon in drug-induced lupus erythematosus. - This statement accurately reflects a key differentiating feature from idiopathic systemic lupus erythematosus (SLE), where CNS involvement can be significant [1]. *Renal involvement not common* - **Renal involvement** is rare in drug-induced lupus erythematosus. - This statement is true and helps distinguish drug-induced lupus from idiopathic SLE, where renal disease (lupus nephritis) is a frequent and serious complication [1].

Q: In long standing rheumatoid arthritis, which condition is commonly observed?

Secondary amyloidosis. ***Secondary amyloidosis*** - Chronic inflammation in **rheumatoid arthritis** can lead to the production and deposition of **amyloid A protein**, which is the hallmark of secondary (AA) amyloidosis [1]. - **Secondary amyloidosis** can affect various organs, including the kidneys, heart, and gastrointestinal tract, leading to organ dysfunction [1]. *Milk alkali syndrome* - This condition is caused by excessive intake of **calcium** and absorbable alkali, resulting in **hypercalcemia** and **metabolic alkalosis**. - It is not directly associated with the chronic inflammatory process of rheumatoid arthritis. *Nephrolithiasis* - **Kidney stones** (nephrolithiasis) are often associated with genetic predispositions, dietary factors, and certain metabolic conditions like **hypercalciuria** or **hyperoxaluria**. - There is no direct causal link between **rheumatoid arthritis** and an increased risk of common types of kidney stones. *Paradoxical aciduria* - This condition is characterized by the excretion of acidic urine in the presence of **metabolic alkalosis**, typically due to **volume depletion** and **hypokalemia**. - While it reflects a disturbance in acid-base balance and renal function, it is not a direct or commonly observed complication of long-standing rheumatoid arthritis itself.

Q: All of the following are true about Gout, except which of the following?

Occurs more in females. ***Occurs more in females*** - **Gout** is more prevalent in **males** than in females, especially before menopause, due to hormonal differences and lifestyle factors. - After menopause, the incidence in females increases but generally remains lower than in males. *Occurs due to accumulation of urate crystals in joint* - **Gout** is precisely characterized by the **deposition of monosodium urate crystals** in joints and surrounding tissues, leading to inflammation [1], [2]. - This accumulation is a direct consequence of **hyperuricemia**, either from overproduction or underexcretion of uric acid [2], [3]. *Can be precipitated by pyrazinamide* - **Pyrazinamide** is an anti-tuberculosis drug known to **inhibit uric acid excretion** by the kidneys. - This leads to **hyperuricemia**, thereby increasing the risk of acute gout attacks. *Birefringent crystals are present in the joint* - Microscopic examination of **synovial fluid** from a gouty joint reveals **needle-shaped, negatively birefringent crystals** of monosodium urate [1], [4]. - This finding is a definitive diagnostic criterion for **gout**.

Q: What is the primary cause of Common Variable Immunodeficiency (CVID)?

Defective B cell differentiation. ***Defective B cell differentiation*** - CVID is characterized primarily by a failure of **B cells** to differentiate into **plasma cells**, which are responsible for producing antibodies [1]. - This defective differentiation leads to **hypogammaglobulinemia**, or low levels of immunoglobulins [1]. *Absent B cells* - Complete absence of B cells is characteristic of severe combined immunodeficiency (SCID) or X-linked agammaglobulinemia (XLA), not CVID [1]. - In CVID, B cells are typically present, but they are dysfunctional. *Reduced number of B cells* - While some patients with CVID may have reduced B cell numbers, this is not the primary or defining defect. - The key issue is the inability of existing B cells to mature and produce antibodies effectively. *Defective B cell function* - While B cell function is indeed defective in CVID, the root cause of this malfunction is specifically the **failure of differentiation** into mature plasma cells. - The B cells are unable to perform their primary function of antibody production due to this arrest in their development.

Q: Which condition is not associated with complement deficiency?

Membranous nephritis. Membranous nephritis - Membranous nephritis is associated with immune complex deposition rather than complement deficiencies. [1] - The disease is characterized by thickening of the glomerular basement membrane without significant complement involvement. [1] PNH - Paroxysmal nocturnal hemoglobinuria (PNH) is due to a defect in the GPI-anchor leading to complement-mediated hemolysis. - Complement activation plays a critical role in the destruction of red blood cells in this condition. Hereditary angioedema - Hereditary angioedema is caused by deficiencies in C1 inhibitor, leading to uncontrolled activation of complement. - This results in edema episodes, directly linked to complement pathway dysregulation. SLE - Systemic lupus erythematosus (SLE) involves complement consumption due to autoantibody formation against nuclear antigens. - The disease often presents with hypocomplementemia, indicating complement system involvement.

Q: Which type of artery is most commonly involved in PAN?

Muscular. ***Muscular*** - **Polyarteritis nodosa (PAN)** predominantly affects **medium to small-sized muscular arteries**, leading to inflammation, necrosis, and microaneurysms [1]. - This involvement often causes **organ ischemia** and symptoms related to the affected organs, such as the kidneys, gastrointestinal tract, and skin [1]. *Elastic* - **Elastic arteries**, such as the aorta and its major branches, are typically spared in PAN due to their larger size and distinct histological structure. - Diseases like **Takayasu arteritis** or **Giant cell arteritis** are more commonly associated with vasculitis affecting large elastic arteries. *Arterioles* - While arterioles can be affected in various forms of vasculitis, they are not the primary target in classic PAN. - Involvement of arterioles is more characteristic of **microscopic polyangiitis** or **Churg-Strauss syndrome** [2]. *Capillaries* - **Capillaries** are the smallest blood vessels, and their involvement is rare in PAN. - Conditions like **Henoch-Schönlein purpura** or some drug-induced vasculitides more typically affect capillaries, often resulting in palpable purpura [2].

Q: Which of the following is a key feature of microscopic polyangiitis?

Renal involvement in 80% of cases. ***Renal involvement in 80% of cases*** - Microscopic polyangiitis is characterized by significant **renal involvement**, with **glomerulonephritis** seen in approximately **80%** of patients. - The condition is associated with **pauci-immune** vasculitis, leading to **rapidly progressive renal failure** [1]. *Bronchospasm* - While bronchospasm can occur in various allergic and respiratory conditions, it is not a classical feature of microscopic polyangiitis. - The disease primarily affects **small vessels** and is not associated with **airway hyperreactivity**. *All of the above* - This option is incorrect as not all listed choices correctly represent features of microscopic polyangiitis. - Specifically, **bronchospasm** and **IgG deposits in the kidney** are not typical indicators of the condition. *IgG deposits in kidney* - Microscopic polyangiitis generally presents with **pauci-immune** glomerulonephritis, often with no significant **IgG deposits** on immunofluorescence [1]. - Renal pathology typically shows **crescentic lesions**, not IgG-mediated damage [1].

Q: Shrinking Lung Syndrome is seen in:

SLE. ***SLE*** - **Shrinking lung syndrome (SLS)** is a rare but recognized pulmonary manifestation of **systemic lupus erythematosus (SLE)** [1]. - It is characterized by **dyspnea**, **pleuritic chest pain**, and elevated diaphragms with reduced lung volumes, often without significant interstitial lung disease [1]. *Rheumatoid Arthritis* - While **rheumatoid arthritis** can cause various lung manifestations like **interstitial lung disease (ILD)**, pleural effusions, and rheumatoid nodules, **shrinking lung syndrome** is not typically associated with it [2]. - Lung disease in RA often involves **pulmonary fibrosis** or bronchiolitis, differing from the restrictive physiology of SLS. *Scleroderma* - **Scleroderma (Systemic Sclerosis)** commonly affects the lungs, primarily leading to **interstitial lung disease (ILD)** and **pulmonary hypertension** [1]. - **Shrinking lung syndrome**, with its characteristic restrictive pattern and elevated diaphragms, is not a typical presentation of lung involvement in scleroderma. *Sarcoidosis* - **Sarcoidosis** is characterized by the formation of **non-caseating granulomas**, primarily affecting the lungs and lymph nodes. - Lung involvement in sarcoidosis typically presents as **interstitial lung disease** or nodular infiltrates, not the distinct features of **shrinking lung syndrome** [3].

Question 1

Most common precipitant of Raynaud's phenomenon is

Accepted Answer

Exposure to cold

Answer

Exposure to heat

Answer

Psychosocial triggers

Answer

Exertion

Question 2

Which of the following antibodies is highly specific for systemic lupus erythematosus?

Accepted Answer

Anti-Sm

Answer

Anti-RO-1

Answer

Anti-Centromere

Answer

Anti-U1RNP

Question 3

Which of the following statements about drug-induced SLE is NOT true?

Accepted Answer

Female: Male ratio=1:9

Answer

CNS involvement not common

Answer

Renal involvement not common

Answer

Anti-histone antibodies are negative

Question 4

In long standing rheumatoid arthritis, which condition is commonly observed?

Accepted Answer

Secondary amyloidosis

Answer

Milk alkali syndrome

Answer

Nephrolithiasis

Answer

Paradoxical aciduria

Question 5

All of the following are true about Gout, except which of the following?

Accepted Answer

Occurs more in females

Answer

Can be precipitated by pyrazinamide

Answer

Birefringent crystals are present in the joint

Answer

Occurs due to accumulation of urate crystals in joint

Question 6

What is the primary cause of Common Variable Immunodeficiency (CVID)?

Accepted Answer

Defective B cell differentiation

Answer

Defective B cell function

Answer

Absent B cells

Answer

Reduced number of B cells

Question 7

Which condition is not associated with complement deficiency?

Accepted Answer

Membranous nephritis

Answer

SLE

Answer

PNH

Answer

Hereditary angioedema

Question 8

Which type of artery is most commonly involved in PAN?

Accepted Answer

Muscular

Answer

Capillaries

Answer

Elastic

Answer

Arterioles

Question 9

Which of the following is a key feature of microscopic polyangiitis?

Accepted Answer

Renal involvement in 80% of cases

Answer

All of the options

Answer

IgG deposits in kidney

Answer

Bronchospasm

Question 10

Shrinking Lung Syndrome is seen in:

Accepted Answer

SLE

Answer

Rheumatoid Arthritis

Answer

Scleroderma

Answer

Sarcoidosis

Rheumatology and Immunology — MCQs

Rheumatology and Immunology — MCQs

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