Rheumatology and Immunology — MCQs

Rheumatology and Immunology Indian Medical PG Practice Questions and MCQs

Question 911: Jaw tightness is typically seen in:

A. Coarctation of aorta
B. Giant cell arteritis (GCA) (Correct Answer)
C. Polyarteritis nodosa (PAN)
D. Granulomatosis with Polyangiitis (GPA)

Explanation: ***Giant cell arteritis (GCA)*** - **Jaw claudication** or tightness, difficulty chewing, and pain in the jaw are classic symptoms of GCA, resulting from **ischemia of the masticatory muscles**. [1] - This condition is a **large vessel vasculitis** that frequently affects the **temporal arteries** and can lead to blindness if untreated. [1] *Polyarteritis nodosa (PAN)* - PAN is a **necrotizing vasculitis** that typically affects **medium-sized arteries**, often sparing the pulmonary circulation. [1] - Common symptoms include **neuropathy**, abdominal pain, and skin lesions (e.g., livedo reticularis), but **jaw tightness is not a typical feature**. *Coarctation of aorta* - This is a **congenital narrowing of the aorta**, leading to symptoms like **upper extremity hypertension**, headache, and claudication in the lower extremities. - **Jaw tightness is not a symptom** associated with coarctation of the aorta. *Granulomatosis with Polyangiitis (GPA)* - GPA is a **small-vessel vasculitis** characterized by **granulomatous inflammation** involving the upper and lower respiratory tracts, and glomerulonephritis. - Symptoms often include **sinusitis**, lung nodules, and kidney disease, but **jaw claudication is not a characteristic presentation**.

Question 912: Oculoorogenital ulcers are associated with which of the following conditions?

A. Lichen planus
B. Behcet's disease (Correct Answer)
C. Systemic lupus erythematosus (SLE)
D. Psoriasis

Explanation: ***Behcet's disease*** - This condition is characterized by **recurrent oral and genital ulcers**, along with **ocular inflammation** (e.g., uveitis), perfectly matching the "Oculoorogenital ulcers" description. - It is a **chronic, relapsing inflammatory disease** of unknown etiology involving vasculitis affecting various organ systems. *Lichen planus* - This is a chronic inflammatory condition affecting the **skin, hair, nails, and mucous membranes**. - While it can cause oral lesions, it typically presents as **purple, polygonal, pruritic papules** on the skin and does not cause genital ulcers or significant ocular involvement like Behcet's. *Systemic lupus erythematosus (SLE)* - SLE is a **systemic autoimmune disease** with diverse manifestations, including skin rashes, arthritis, and internal organ involvement. - Oral ulcers can occur, but **genital ulcers and severe ocular inflammation** as a prominent triad are not typical diagnostic features of SLE. *Psoriasis* - This is a common **chronic inflammatory skin disease** characterized by well-demarcated erythematous plaques with silvery scales. - Psoriasis primarily affects the skin and joints, and **does not typically present with oral, genital, or ocular ulcers** as described.

Question 913: Antibodies most commonly seen in drug induced lupus are:

A. Anti ds DNA Antibodies
B. Anti Sm Antibodies
C. Anti-Ro Antibodies
D. Antihistone Antibodies (Correct Answer)

Explanation: ***Antihistone Antibodies*** - **Antihistone antibodies** are the most common laboratory finding, present in 95% of patients with **drug-induced lupus erythematosus (DIL)**. - This type of lupus is often triggered by medications such as **procainamide**, **hydralazine**, and **isoniazid**. *Anti ds DNA Antibodies* - **Anti-double-stranded DNA (dsDNA) antibodies** are highly specific for **systemic lupus erythematosus (SLE)**, particularly severe cases, but are rarely seen in DIL. - High titers of anti-dsDNA often correlate with **lupus nephritis** and disease activity. *Anti Sm Antibodies* - **Anti-Sm antibodies** are highly specific for **SLE**, sometimes associated with neuropsychiatric manifestations, but are rarely identified in drug-induced lupus. - Their presence helps to confirm the diagnosis of SLE but not DIL. *Anti-Ro Antibodies* - **Anti-Ro (SSA) antibodies** are most commonly associated with **Sjögren's syndrome** and **neonatal lupus**, and can be seen in a subset of SLE patients, especially those with photosensitivity. - While they can be present in some forms of SLE, they are not the hallmark autoantibody for drug-induced lupus.

Question 914: Hereditary angioneurotic edema is due to?

A. Deficiency of C1 inhibitor (Correct Answer)
B. Deficiency of NADPH oxidase
C. Deficiency of MPO
D. Deficiency of properdin

Explanation: ***Deficiency of C1 inhibitor*** - **Hereditary angioedema (HAE)** is caused by a genetic deficiency or dysfunction of the **C1 esterase inhibitor (C1-INH)** protein. - C1-INH normally regulates the **complement system**, kinin system (mediating **bradykinin** release), and coagulation pathways, and its deficiency leads to uncontrolled activation and excessive bradykinin production, causing angioedema. *Deficiency of NADPH oxidase* - A deficiency in **NADPH oxidase** is associated with **Chronic Granulomatous Disease (CGD)**, a primary immunodeficiency characterized by recurrent bacterial and fungal infections due to impaired phagocytic oxidative burst. - It does not cause angioedema, which involves fluid extravasation rather than impaired microbial killing. *Deficiency of MPO* - **Myeloperoxidase (MPO) deficiency** typically leads to mild to moderate impairment in the killing of certain microorganisms by phagocytes but is often asymptomatic or causes only recurrent candidal infections. - It is not linked to the pathogenesis of angioedema, which involves dysregulation of vasoactive peptides. *Deficiency of properdin* - A deficiency in **properdin** affects the **alternative pathway of the complement system**, increasing susceptibility to **Neisseria infections**. - While properdin is part of the complement system, its deficiency does not directly lead to the uncontrolled production of bradykinin, which is the primary mediator in angioedema due to C1-INH deficiency.

Question 915: What is the most likely diagnosis for a young patient presenting with iritis and joint pain?

A. Gout
B. RA
C. AS (Correct Answer)
D. Toxoplasma

Explanation: ***AS (Ankylosing Spondylitis)*** - **Iritis** (anterior uveitis) is a common extra-articular manifestation of **ankylosing spondylitis**, affecting up to 40% of patients [1]. - **Joint pain**, particularly in the axial skeleton (spine and sacroiliac joints), is a hallmark feature in young patients with AS [1]. *Gout* - Characterized by **recurrent attacks of acute inflammatory arthritis** due to **monosodium urate crystal deposition**. - While it causes severe joint pain, **iritis is not a typical manifestation** of gout. *RA (Rheumatoid Arthritis)* - RA is a **chronic autoimmune inflammatory disease** primarily affecting the **synovial joints** symmetrically, mostly in older adults. - While ocular manifestations like **scleritis** or **episcleritis** can occur, **iritis is less common** compared to AS. *Toxoplasma* - **Toxoplasmosis** primarily causes **chorioretinitis** (inflammation of the choroid and retina), not typically isolated iritis. - Although it can cause **arthralgia** (joint pain), it does not cause inflammatory arthritis like the spondyloarthropathies.

Question 916: Raynaud's phenomenon is associated with which of the following conditions?

A. Peripheral artery disease
B. Hyperthyroidism
C. Systemic sclerosis (scleroderma) (Correct Answer)
D. Lupus erythematosus

Explanation: ***Systemic sclerosis (scleroderma)*** - **Raynaud's phenomenon** is a common and often the initial symptom of systemic sclerosis, occurring in over 90% of patients [1]. - It involves recurrent vasospasm of the digits, leading to characteristic **triphasic color changes** (white, blue, red) and can be a predictor of later systemic disease [1]. *Peripheral artery disease* - This condition involves **atherosclerosis** and arterial narrowing, primarily affecting larger arteries in the limbs, leading to exertional pain (claudication). - While it can restrict blood flow, its pathophysiology and symptoms are distinct from the vasospastic episodes seen in Raynaud's phenomenon. *Hyperthyroidism* - **Hyperthyroidism** causes a hypermetabolic state with symptoms like heat intolerance, weight loss, and tachycardia due to excessive thyroid hormone. - It does not directly cause vasospastic episodes or the characteristic color changes associated with Raynaud's phenomenon. *Lupus erythematosus* - While Raynaud's phenomenon can occur in **Lupus erythematosus** (SLE), it is less universally associated and less prominent than in systemic sclerosis. - SLE is a multisystem autoimmune disease characterized by a wide range of symptoms, including skin rashes, arthritis, and organ involvement, differing from the primary vascular focus of Raynaud's in scleroderma.

Question 917: Which of these is characteristic of gout?

A. Podagra (Correct Answer)
B. Anasarca
C. Calcinosis cutis
D. Cheiroarthropathy

Explanation: ***Podagra*** - This refers to the **inflammation of the big toe**, which is a classic presentation of gout [2]. - Gout is characterized by an **acute attack** of arthritis, commonly affecting peripheral joints, notably the **first metatarsophalangeal joint** [1]. *Cheiroarthropathy* - This condition involves **joint stiffness** and deformity, typically seen in **diabetes mellitus**, not gout. - It does not present with the **acute, inflammatory attacks** characteristic of gout [1]. *Calcinosis cutis* - This is a skin condition involving **calcium deposits**, often seen in **systemic sclerosis** or dermatomyositis. - It is not directly related to the **uric acid metabolism** issues or **joint inflammation** seen in gout. *Anasarca* - This term describes **generalized edema**, which can result from various conditions like heart failure or renal failure. - It is not specific to gout and does not involve the **acute joint inflammation** hallmark of the disease [1]. **References:** [1] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, p. 1218. [2] Kumar V, Abbas AK, et al.. Robbins and Cotran Pathologic Basis of Disease. 9th ed. Bones, Joints, and Soft Tissue Tumors, pp. 1218-1220.

Question 918: HLA marker of Behcet's syndrome is what?

A. B27
B. DR5
C. B51 (Correct Answer)
D. CW6

Explanation: ***B51*** - **HLA-B51** is the most strongly associated genetic marker with **Behçet's syndrome**, particularly in populations from the Middle East and East Asia. - While not universally present in all Behçet's patients, its presence significantly increases susceptibility and is considered a **risk factor**. *B27* - **HLA-B27** is strongly associated with **seronegative spondyloarthropathies** such as ankylosing spondylitis, reactive arthritis, and psoriatic arthritis, [1] not Behçet's syndrome. - It plays a role in the pathogenesis of these conditions by influencing antigen presentation. [1] *DR5* - While various **HLA-DR alleles** are linked to autoimmune diseases (e.g., DR4 with rheumatoid arthritis, DR3 with SLE), **HLA-DR5** does not have a primary association with Behçet's syndrome. - Behçet's syndrome's primary genetic link is to Class I MHC alleles, specifically HLA-B51. *CW6* - **HLA-Cw6** is strongly associated with **psoriasis vulgaris**, [2] a chronic inflammatory skin condition. - It is not a recognized genetic marker for **Behçet's syndrome**.

Question 919: Which joint is LEAST commonly affected in early rheumatoid arthritis?

A. Knee
B. Ankle
C. Tarsometatarsal (Correct Answer)
D. Metatarsophalangeal

Explanation: ***Tarsometatarsal*** - The **tarsometatarsal joints** (Lisfranc joints) are deep within the foot and are relatively protected, making them less commonly involved in early RA. - While other foot joints like the metatarsophalangeal joints are frequently affected, the tarsometatarsals typically show involvement only in **advanced or severe disease**. *Knee* - The knee is a **large weight-bearing joint** that can be affected in RA but is less frequently involved in the **very early stages** compared to smaller joints [1]. - Though not a primary initial target, **synovitis and effusions** can develop as the disease progresses. *Ankle* - The ankle joint can be involved in RA, but it is **less common than the small joints of the hands and feet** in early disease [1]. - When affected, it typically presents with **pain, swelling, and stiffness**, impacting gait. *Metatarsophalangeal* - The **metatarsophalangeal (MTP) joints** are very commonly affected in early rheumatoid arthritis due to their synovial lining and frequent use [1]. - Involvement here often leads to **pain, swelling, and difficulty walking**, being a significant diagnostic criterion [2].

Question 920: Which of the following is not a primary symptom of Sjögren's syndrome?

A. Parotid gland enlargement
B. Dry eyes
C. Dry mouth
D. Systemic manifestations (Correct Answer)

Explanation: ***Systemic manifestations*** - While Sjögren's syndrome can have **systemic manifestations**, they are secondary complications or features, not among the **primary, defining symptoms** that establish the diagnosis. - The primary symptoms directly relate to **exocrine gland dysfunction**, specifically lacrimal and salivary glands. *Dry eyes* - This is a cardinal symptom, resulting from damage to the **lacrimal glands** leading to decreased tear production. - Patients typically report a **gritty or burning sensation** in their eyes. *Dry mouth* - Another core symptom, resulting from dysfunction of the **salivary glands** and reduced saliva flow. - This can lead to difficulties in **speaking, swallowing**, increased dental carries, and oral discomfort. *Parotid gland enlargement* - This is a common and often **visible clinical sign** of Sjögren's syndrome, indicating inflammation of the **major salivary glands**. - It results from lymphocytic infiltration and is typically recurrent or persistent.

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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