Rheumatology and Immunology — MCQs

Rheumatology and Immunology Indian Medical PG Practice Questions and MCQs

Question 901: Which of the following is a characteristic feature of Granulomatosis with polyangiitis?

A. Nasal polyp
B. Perforated nasal septum (Correct Answer)
C. Persistent sinusitis
D. Collapse of nasal bridge

Explanation: ***Perforated nasal septum*** - **Granulomatosis with polyangiitis (GPA)**, previously known as **Wegener's granulomatosis**, is characterized by **granulomatous inflammation** and **vasculitis** of small to medium-sized vessels, particularly affecting the upper and lower respiratory tracts, and the kidneys [1]. - Damage to the nasal cartilage and bone due to inflammation and vasculitis can lead to a **perforation of the nasal septum**, which is a classic feature. *Nasal polyp* - While nasal polyps can occur in inflammatory conditions, they are **not a specific or highly characteristic feature** of Granulomatosis with polyangiitis compared to septal perforation. - **Allergic rhinitis** or **chronic rhinosinusitis** are more commonly associated with nasal polyps. *Persistent sinusitis* - **Persistent sinusitis** (rhinosinusitis) is a very common initial manifestation of Granulomatosis with polyangiitis due to upper airway inflammation. - However, it's a **less specific finding** than a perforated septum, as sinusitis can be caused by many other conditions. *Collapse of nasal bridge* - **Collapse of the nasal bridge**, also known as a **saddle nose deformity**, can occur in advanced or destructive cases of Granulomatosis with polyangiitis due to extensive cartilage and bone destruction. - While possible, a **perforated nasal septum often precedes** or is a more direct, earlier indicator of the destructive process in the nose.

Question 902: All are seen in Behçet's syndrome except:

A. Pyoderma gangrenosum (Correct Answer)
B. Erythema nodosum
C. Genital ulcers
D. Oral ulcers

Explanation: ***Pyoderma gangrenosum*** - While Behçet's syndrome can involve skin lesions, **pyoderma gangrenosum** is not typically part of its diagnostic criteria or common manifestations. - Pyoderma gangrenosum is a distinct neutrophilic dermatosis characterized by rapidly enlarging, painful ulcers. *Erythema nodosum* - **Erythema nodosum** is a common dermatological manifestation in Behçet's syndrome, characterized by tender subcutaneous nodules, usually on the shins. - These lesions reflect the systemic inflammatory nature of the disease in various organs. *Genital ulcers* - **Genital ulcers** are one of the major diagnostic criteria for Behçet's syndrome, often painful and recurrent. - They tend to be deep and can form scars, appearing on the scrotum, penis, labia, or perianal area. *Oral ulcers* - **Recurrent oral aphthous ulcers** are the most common and often the initial symptom of Behçet's syndrome. - These ulcers are typically painful, varying in size, and can occur on any mucosal surface in the mouth.

Question 903: Which type of arthritis is characterized by the absence of a periosteal reaction?

A. Psoriatic arthritis
B. Neuropathic arthritis (Correct Answer)
C. Rheumatoid arthritis
D. Reactive arthritis

Explanation: ***Neuropathic arthritis*** - **Neuropathic arthritis** (**Charcot joint**) is characterized by progressive joint destruction due to loss of proprioception and pain sensation, leading to severe bone and joint damage without a typical **periosteal reaction**. - The absence of normal protective reflexes results in repetitive microtrauma, often leading to bone resorption and fragmentation rather than new bone formation (periosteal reaction). *Psoriatic arthritis* - **Psoriatic arthritis** often presents with distinctive **periosteal reactions**, particularly at entheses and along the shafts of small bones (e.g., "pencil-in-cup" deformities and fluffy periostitis) [1]. - These periosteal changes are a hallmark of the inflammatory process affecting bone and connective tissues in psoriatic arthritis. *Rheumatoid arthritis* - **Rheumatoid arthritis** primarily involves the synovium, leading to erosions rather than prominent periosteal reactions in early stages [1]. - While periostitis can occur in chronic, destructive rheumatoid arthritis, it is not a primary or characteristic finding compared to other inflammatory arthritides. *Reactive arthritis* - **Reactive arthritis** frequently causes **periosteal reactions**, particularly at entheses (where tendons and ligaments attach to bone) and along the shafts of long bones, often described as "fluffy" periostitis [1]. - These new bone formations are a key radiological feature distinguishing it from other types of inflammatory arthritis.

Question 904: Which of the following is NOT a characteristic feature of systemic sclerosis?

A. Calcinosis cutis
B. Digital ulcers
C. Acroosteolysis
D. Gottron's papules (Correct Answer)

Explanation: ***Gottron's papules*** - **Gottron's papules** are pathognomonic for **dermatomyositis**, not systemic sclerosis. They are red, scaling papules found over the extensor surfaces of the metacarpophalangeal (MCP) and interphalangeal (IP) joints. - While both systemic sclerosis and dermatomyositis are connective tissue diseases, their distinct cutaneous manifestations aid in differentiation. *Acroosteolysis* - **Acroosteolysis** refers to the resorption of the distal phalanges, a common feature in systemic sclerosis, particularly in severe cases. - This symptom contributes to the characteristic digital abnormalities seen in the disease. *Calcinosis cutis* - **Calcinosis cutis** is the deposition of calcium in the skin and subcutaneous tissues, often seen in subsets of systemic sclerosis, especially the CREST syndrome. - It can manifest as firm, white-yellow nodules or plaques and contribute to skin breakdown. *Digital ulcers* - **Digital ulcers** are a frequent and debilitating complication of systemic sclerosis, resulting from severe **vasculopathy** [1] and **ischemia** [1]. - They are often painful and can lead to significant tissue loss and infection.

Question 905: Which of the following is NOT a feature of scleroderma?

A. Restrictive cardiomyopathy
B. Halitosis
C. Syndactyly (Correct Answer)
D. Decrease in tone of LES

Explanation: ***Syndactyly*** - **Syndactyly** (fusion of digits) is a congenital anomaly and is **not** a typical feature of scleroderma. - Scleroderma primarily involves **fibrosis** and vascular changes, leading to skin thickening, not digit fusion [1]. *Decrease in tone of LES* - A **decrease in tone of the lower esophageal sphincter (LES)** is a common gastrointestinal manifestation of scleroderma. - This leads to **gastroesophageal reflux disease (GERD)** and related symptoms due to smooth muscle atrophy and fibrosis. *Restrictive cardiomyopathy* - **Restrictive cardiomyopathy** can occur in scleroderma due to **myocardial fibrosis**, leading to impaired diastolic filling. - This is a serious cardiac complication that can cause **heart failure**. *Halitosis* - **Halitosis** (bad breath) can be an indirect manifestation of scleroderma, often associated with severe **GERD**. - Impaired esophageal motility and reflux are common in scleroderma and can contribute to dental problems and **oral dysbiosis**, which can cause halitosis.

Question 906: Which antibodies in a mother with SLE are responsible for congenital heart disease in the child?

A. Anti-ds DNA
B. Anti-Ro & Anti-La (Correct Answer)
C. Anti-centromere
D. Anti-histone

Explanation: ***Anti-Ro & Anti-La*** - These antibodies are actively transported across the **placenta** and can target fetal cardiac tissue, leading to **congenital heart block** [2]. - They are classically associated with **neonatal lupus erythematosus**, which includes congenital heart block and transient skin lesions [1], [2]. *Anti-histone* - **Anti-histone antibodies** are primarily associated with **drug-induced lupus erythematosus**, rather than congenital heart defects. - While present in some SLE patients, they do not have a direct causal link to fetal cardiac abnormalities. *Anti-ds DNA* - **Anti-dsDNA antibodies** are highly specific for **systemic lupus erythematosus (SLE)** and are associated with disease activity, especially **lupus nephritis** [1]. - They are not directly implicated in causing congenital heart disease in the offspring. *Anti-centromere* - **Anti-centromere antibodies** are characteristic of **CREST syndrome**, a limited form of systemic sclerosis. - They are not found in SLE and thus have no role in SLE-related congenital heart disease.

Question 907: Most common cause of death in SLE in children

A. Libman sacks endocarditis
B. Lupus cerebritis
C. Lupus nephritis
D. Anemia and infections (Correct Answer)

Explanation: ***Anemia and infections*** - **Infections** are a leading cause of death in pediatric SLE patients, often due to immunosuppression from the disease itself or its treatment. Although pediatric Systemic Lupus Erythematosus (SLE) is not a primary immune deficiency, the susceptibility to encapsulated bacteria and recurrent infections seen in primary B- and T-lymphocyte deficiencies mirrors the infection risks managed in these patients [1]. - **Anemia** can contribute to overall morbidity and mortality, although it is less directly a cause of death than severe infections or organ failure. *Lupus nephritis* - While **lupus nephritis** is a common and severe manifestation of SLE in children and a major cause of morbidity, particularly long-term kidney failure, it is not the most frequent immediate cause of death. - Advancements in treatment for nephritis have improved prognosis, shifting the leading cause of mortality to other factors. *Lupus cerebritis* - **Lupus cerebritis** (neuropsychiatric SLE) can be life-threatening, causing seizures, stroke, or psychosis, but it is less common as the primary cause of death compared to infections. - Its presence usually indicates severe disease requiring intensive treatment, but not the most common direct cause of death. *Libman sacks endocarditis* - **Libman-Sacks endocarditis** involves sterile vegetations on heart valves and is a known complication of SLE, but it rarely causes acute mortality in children. - It is more often associated with chronic complications like valvular dysfunction or a source of emboli rather than being the most common cause of death.

Question 908: In a patient presenting with symptoms of drug-induced lupus erythematosus, which antibody is most commonly found?

A. Ds-DNA
B. Anti-Sm
C. Anti-histone antibody (Correct Answer)
D. Anti-Ro

Explanation: ***Anti-histone antibody*** - **Anti-histone antibodies** are present in approximately 90-95% of patients with **drug-induced lupus erythematosus**. - Their presence, especially with a history of exposure to an inducing drug such as **hydralazine** or **procainamide**, strongly suggests this diagnosis. *Anti-Ro* - **Anti-Ro antibodies** are more commonly associated with **Sjogren's syndrome** and **neonatal lupus**, rather than drug-induced lupus [1]. - While they can be present in systemic lupus erythematosus, they are not the hallmark antibody for the drug-induced form. *Ds-DNA* - **Anti-double-stranded DNA (anti-dsDNA) antibodies** are highly specific for **systemic lupus erythematosus (SLE)** and often correlate with disease activity, particularly **lupus nephritis**. - They are typically **negative** or present in very low titers in drug-induced lupus erythematosus. *Anti-Sm* - **Anti-Smith (anti-Sm) antibodies** are highly specific for **systemic lupus erythematosus (SLE)** and are considered a diagnostic marker for the disease [1]. - They are rarely found in patients with drug-induced lupus erythematosus.

Question 909: What is the primary condition associated with positive anti-dsDNA antibodies?

A. RA
B. SLE (Correct Answer)
C. Scleroderma
D. PAN

Explanation: ***SLE*** - **Anti-dsDNA antibodies** are a highly specific marker for **Systemic Lupus Erythematosus (SLE)** and are included in its diagnostic criteria [1]. - The levels of **anti-dsDNA antibodies** can also correlate with disease activity, particularly in cases of **lupus nephritis** [1]. *RA* - **Rheumatoid Arthritis (RA)** is primarily associated with **rheumatoid factor (RF)** and **anti-citrullinated protein antibodies (ACPA)** or **anti-CCP antibodies**. - While ANA (antinuclear antibodies) can be positive in RA, **anti-dsDNA antibodies** are not a characteristic serological marker [1]. *Scleroderma* - **Scleroderma**, or systemic sclerosis, is characterized by specific antibodies such as **anti-Scl-70 (topoisomerase I)**, **anti-centromere antibodies**, and **anti-RNA polymerase III antibodies**, depending on the subtype. - **Anti-dsDNA antibodies** are not typically found in scleroderma and do not play a role in its diagnosis [1]. *PAN* - **Polyarteritis Nodosa (PAN)** is a **necrotizing vasculitis** of medium-sized arteries and is not associated with **anti-dsDNA antibodies**. - PAN is generally considered an **ANCA-negative vasculitis**, and its diagnosis relies more on clinical features, angiography, and biopsy findings.

Question 910: Which of the following is a characteristic feature of primary Sjogren's syndrome?

A. Can occur in children
B. Increased complement C4 is associated with thymoma
C. Can be associated with rheumatoid arthritis
D. Enlargement of salivary glands (Correct Answer)

Explanation: ***Enlargement of salivary glands*** - **Sjögren's syndrome** is characterized by chronic inflammation of **exocrine glands**, leading to swelling and dysfunction, most notably in the **parotid** and **submandibular glands**. - This glandular enlargement often presents as recurrent or persistent **bilateral swelling** of the major salivary glands. *Can occur in children* - While possible, Sjögren's syndrome is predominantly a disease of **adults**, with incidence peaking in individuals between **40 and 60 years old**. - **Juvenile Sjögren's syndrome** is rare and typically presents with more variable symptoms, making it less of a characteristic feature of the primary disease in the general population. *Increased complement C4 is associated with thymoma* - **Increased complement C4** levels are generally not associated with Sjögren's syndrome; instead, **hypocomplementemia** (low C4) can be seen in some patients, indicating immune complex activity. - **Thymoma** is primarily linked to **myasthenia gravis** and other paraneoplastic syndromes, not a direct or characteristic association with Sjögren's syndrome or C4 levels in this context. *Can be associated with rheumatoid arthritis* - Sjögren's syndrome can be classified as **primary** (occurring alone) or **secondary** (occurring in conjunction with another autoimmune disease). - Its association with **rheumatoid arthritis** defines **secondary Sjögren's syndrome**, meaning it's not a characteristic feature of the *primary* form of the disease itself.

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

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