Rheumatology and Immunology — MCQs

Rheumatology and Immunology Indian Medical PG Practice Questions and MCQs

Question 931: Lady presents with joint pain in both knees and low-grade fever, which occurs intermittently. On examination, she has a rash on sun-exposed areas. What is the clinical diagnosis?

A. Systemic lupus erythematosus (SLE) (Correct Answer)
B. Rheumatoid arthritis (RA)
C. Photodermatitis
D. Porphyria cutanea tarda

Explanation: ***Systemic lupus erythematosus (SLE)*** - The combination of **polyarthralgia (joint pain)**, **low-grade fever**, and a **photosensitive rash** is highly characteristic of SLE. [1] - SLE is a **multisystem autoimmune disease** that can affect joints, skin, and cause constitutional symptoms like fever. [1] *Rheumatoid arthritis (RA)* - While RA causes **joint pain**, it typically presents with **symmetrical polyarthritis** primarily affecting small joints, and a photosensitive rash is not a common feature. [2] - **Fever** can be present in severe RA, but the triad of symptoms in this case points away from RA as the primary diagnosis. *Photodermatitis* - **Photodermatitis** is a skin inflammation caused by sunlight exposure, resulting in a rash. - This diagnosis does not account for the **joint pain** or **low-grade fever**, which are systemic manifestations. *Porphyria cutanea tarda* - This condition primarily affects the skin, causing **photosensitivity**, blistering lesions, and increased fragility, especially on sun-exposed areas. - It does **not typically present with joint pain or fever**, differentiating it from the presented symptoms.

Question 932: A 60-year-old female presenting with proximal muscle weakness, increased serum creatine kinase levels, and no skin manifestations is likely to have:

A. Polymyositis (Correct Answer)
B. Dermatomyositis
C. Limb-girdle muscular dystrophy
D. Inclusion body myositis

Explanation: ***Polymyositis*** - **Polymyositis** primarily affects adults, causing **proximal muscle weakness** (shoulders, hips, thighs) and elevated **creatine kinase (CK)** levels due to muscle damage [1]. - The absence of **skin manifestations** in this case strongly supports polymyositis over dermatomyositis, as dermatomyositis typically presents with characteristic cutaneous features [1]. *Dermatomyositis* - While dermatomyositis can present with identical **proximal muscle weakness** and elevated CK levels, it is characteristically associated with **skin manifestations** [1]. - The absence of **heliotrope rash**, **Gottron papules**, or **shawl sign** in this clinical scenario makes dermatomyositis less likely despite similar muscle involvement [1]. *Limb-girdle muscular dystrophy* - **Limb-girdle muscular dystrophy** is a genetically heterogeneous group of disorders, typically presenting in **childhood or adolescence**, though some forms can manifest later in life. - It causes **progressive symmetric muscle weakness** predominantly affecting the **shoulders and hips**, with highly variable CK levels depending on the specific genetic mutation. *Inclusion body myositis* - **Inclusion body myositis** typically affects older individuals (over 50), presenting with **progressive, asymmetrical muscle weakness**, more prominently in the **distal muscles** (e.g., forearm flexors, quadriceps). - While CK levels can be elevated, they are usually **less markedly increased** than in polymyositis or dermatomyositis, and the disease often progresses more slowly.

Question 933: Behçet's disease is associated with which HLA?

A. HLA-B27
B. HLA-DQ
C. HLA-DR4
D. HLA-B51 (Correct Answer)

Explanation: ***HLA-B51*** - Behçet's disease has a strong association with the **HLA-B51 allele**, particularly in populations from the Mediterranean, Middle East, and Asia. - This genetic predisposition contributes to the inflammatory and autoimmune nature of the disease. *HLA-B27* - This allele is strongly associated with **spondyloarthropathies**, such as **ankylosing spondylitis** and **reactive arthritis**, rather than Behçet's disease [1]. - Patients with HLA-B27 positive status often present with axial skeletal involvement and enthesitis [1]. *HLA-DQ* - HLA-DQ alleles are associated with various autoimmune conditions, including **celiac disease** and **type 1 diabetes mellitus**, but not specifically with Behçet's disease. - The association is generally weaker and less specific compared to HLA-B51 for Behçet's. *HLA-DR4* - **HLA-DR4** is primarily associated with **rheumatoid arthritis**, especially in severe forms of the disease. - It is also associated with other autoimmune diseases but does not play a significant role in the pathogenesis or diagnosis of Behçet's disease.

Question 934: Which of the following is a definite indication for systemic steroids in rheumatoid arthritis?

A. a) Mononeuritis multiplex
B. c) Carpal tunnel syndrome
C. b) Lung involvement (Correct Answer)
D. d) Both 'a' & 'c'

Explanation: ***Lung involvement*** - **Systemic steroids** are indicated for severe **extrapulmonary manifestations** of rheumatoid arthritis, such as **interstitial lung disease**, which can be life-threatening [2]. - They help to reduce **inflammation** and prevent further damage to lung tissue [1]. *Mononeuritis multiplex* - While a serious complication of rheumatoid arthritis, **mononeuritis multiplex** typically warrants treatment with disease-modifying antirheumatic drugs (DMARDs) and sometimes **intravenous immunoglobulins** (IVIG) or **cyclophosphamide**, rather than systemic steroids as a primary or definite indication. - Steroids might be used as an adjunct, but are not the definite first-line sole treatment. *Carpal tunnel syndrome* - **Carpal tunnel syndrome** in rheumatoid arthritis is often managed with **local corticosteroid injections**, **splinting**, or surgical release, depending on severity. - **Systemic steroids** are generally not indicated for localized musculoskeletal complications unless there is overwhelming active systemic disease. *Both 'a' & 'c'* - This option is incorrect because neither **mononeuritis multiplex** nor **carpal tunnel syndrome** is a definite standalone indication for systemic steroids in rheumatoid arthritis, as explained above. - Systemic steroids are reserved for more severe or diffuse manifestations.

Question 935: Juvenile idiopathic arthritis includes all the following categories except:

A. Psoriatic arthritis
B. Enthesitis related arthritis
C. Systemic arthritis
D. Reactive arthritis (Correct Answer)

Explanation: ***Reactive arthritis*** - **Reactive arthritis** is not a subtype of Juvenile Idiopathic Arthritis (JIA); instead, it is a **spondyloarthritis** that typically develops after an infection. - While it can occur in children, its pathogenesis and diagnostic criteria differentiate it from the various JIA categories. *Psoriatic arthritis* - **Psoriatic arthritis** is indeed a recognized category of JIA, characterized by arthritis accompanied by psoriasis or a family history of psoriasis. - It often presents with **dactylitis** (sausage digits) and nail changes in addition to joint involvement. *Enthesitis related arthritis* - **Enthesitis-related arthritis** is a JIA subtype primarily affecting the **entheses** (sites where tendons or ligaments attach to bone) and often the axial skeleton. - It is frequently associated with **HLA-B27 positivity** and occurs more commonly in boys. *Systemic arthritis* - **Systemic arthritis** (formerly Still's disease) is a distinct JIA category characterized by **daily fevers**, skin rash, and internal organ involvement such as hepatosplenomegaly, lymphadenopathy, and serositis. - Arthritis may develop later in the disease course or be less prominent initially compared to systemic symptoms.

Question 936: What is the primary condition associated with atrophic changes in the mucous membranes?

A. Sjogren's syndrome (Correct Answer)
B. Lupus erythematosus
C. Celiac disease
D. Vitamin B12 deficiency

Explanation: ***Sjogren's syndrome*** - It is an **autoimmune disease** primarily characterized by the destruction of exocrine glands, leading to **dryness of mucous membranes** (xerostomia, xerophthalmia) [1]. - The chronic inflammation and lymphocytic infiltration of glands result in **atrophy and dysfunction**, particularly of the salivary and lacrimal glands. *Lupus erythematosus* - While it is an autoimmune disease that can affect multiple organs, its primary manifestation is not typically **atrophic changes in mucous membranes**. [1] - **Oral ulcers** and **photosensitivity** are common, but widespread glandular atrophy is not characteristic [2]. *Celiac disease* - This is an **autoimmune disorder** primarily affecting the **small intestine** due to gluten ingestion, leading to **villous atrophy**. - While it can cause some oral manifestations (e.g., aphthous ulcers), it does not directly cause widespread atrophy of mucous membranes in other parts of the body. *Vitamin B12 deficiency* - Can cause **glossitis** (inflammation of the tongue), which might appear smooth and atrophic due to the loss of papillae. - However, it does not typically lead to systemic atrophy of mucous membranes beyond specific areas like the tongue or a general dryness.

Question 937: What are the common complications associated with hypogammaglobulinemia?

A. Nosebleeds due to vascular issues
B. Muscle contractures unrelated to immune function
C. Eczema as a result of immune dysregulation
D. Chronic recurrent sinusitis due to impaired antibody production (Correct Answer)

Explanation: ***Chronic recurrent sinusitis due to impaired antibody production*** - **Hypogammaglobulinemia** directly impairs the body's ability to produce sufficient **antibodies**, which are crucial for fighting bacterial and viral infections. - This deficiency leads to increased susceptibility to recurrent infections, particularly in the respiratory tract, manifesting as **chronic sinusitis** and otitis media [1]. *Nosebleeds due to vascular issues* - **Nosebleeds** are typically associated with local vascular fragility, trauma, or underlying clotting disorders, not primarily with a systemic immune deficiency like hypogammaglobulinemia. - While immune deficiencies can sometimes cause broader defects in tissue integrity, **epistaxis** is not a hallmark complication. *Muscle contractures unrelated to immune function* - **Muscle contractures** are primarily musculoskeletal issues, often resulting from neurological conditions, prolonged immobilization, or muscular dystrophies. - They have no direct or common connection to the *immune dysregulation* seen in hypogammaglobulinemia. *Eczema as a result of immune dysregulation* - While **eczema** (atopic dermatitis) involves immune dysregulation, it is typically linked to **IgE-mediated hypersensitivity** and barrier dysfunction, not generalized antibody deficiency. - Patients with hypogammaglobulinemia are more prone to infections rather than atopic conditions like eczema.

Question 938: Which of the following is a feature of rheumatoid arthritis?

A. Swan neck deformity
B. Symmetric joint involvement with erosive changes (Correct Answer)
C. Heberden nodes
D. Ulnar deviation of fingers at metacarpophalangeal joint

Explanation: ***Symmetric joint involvement with erosive changes*** - **Rheumatoid arthritis** is characterized by **symmetric polyarthritis**, meaning it affects the same joints on both sides of the body [1]. - The chronic inflammation leads to the destruction of cartilage and bone, resulting in **erosive changes** visible on radiographs [1]. *Heberden nodes* - **Heberden nodes** are characteristic bony enlargements of the **distal interphalangeal (DIP) joints**, typically seen in **osteoarthritis** [1]. - They are not a feature of **rheumatoid arthritis**, which primarily affects the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints [1]. *Swan neck deformity* - **Swan neck deformity** is a classic hand deformity seen in **rheumatoid arthritis**, characterized by hyperextension of the PIP joint and flexion of the DIP joint. - While it is a feature of chronic rheumatoid arthritis, it represents an advanced stage of the disease and is not a defining characteristic of the initial presentation of RA. *Ulnar deviation of fingers at metacarpophalangeal joint* - **Ulnar deviation** is a common deformity in **rheumatoid arthritis**, where the fingers drift towards the ulnar side at the **metacarpophalangeal (MCP) joints**. - This is a clinical manifestation of the disease, but **symmetric joint involvement with erosive changes** is a more fundamental and diagnostic feature.

Question 939: A child presented with non-blanching purpura in the lower limb and recurrent abdominal pain. Which condition is characterized by the deposition of IgA?

A. Henoch-Schönlein purpura (Correct Answer)
B. Granulomatosis with polyangiitis
C. Kawasaki syndrome
D. Takayasu arteritis

Explanation: ***Henoch-Schönlein purpura*** - This condition is a **leukocytoclastic vasculitis** [1] primarily affecting small vessels, characterized by palpable **purpura**, **abdominal pain** [2], and often **arthralgia** and **renal involvement**. - It is defined by the deposition of **IgA immune complexes** in affected small vessels, a key diagnostic feature. *Granulomatosis with polyangiitis* - This is an **ANCA-associated vasculitis** [1] characterized by granulomatous inflammation of the respiratory tract and necrotizing vasculitis, typically affecting small to medium-sized vessels. - It is associated with **antineutrophil cytoplasmic antibodies (ANCA)**, specifically **c-ANCA**, and does not involve IgA deposition. *Kawasaki syndrome* - This is an **acute febrile illness** primarily in young children [3], characterized by inflammation of medium-sized arteries, most notably the **coronary arteries**. - It presents with fever, rash, **conjunctivitis**, and **lymphadenopathy**, but not IgA deposition [3]. *Takayasu arteritis* - This is a **large-vessel vasculitis** [1] primarily affecting the **aorta** and its major branches, leading to stenoses, occlusions, and aneurysms. - It usually presents in young women with symptoms related to **ischemia** of affected organs, and is not associated with IgA deposition or purpura in the lower limbs.

Question 940: Which of the following conditions is not associated with antiphospholipid syndrome?

A. Venous thrombosis
B. Neurological manifestations
C. Thrombocytosis (Correct Answer)
D. Recurrent foetal loss

Explanation: ***Thrombocytosis*** - **Antiphospholipid syndrome (APS)** is characterized by increased **thrombosis** (clotting), not an increase in platelet count (thrombocytosis). - Patients with APS may experience **thrombocytopenia** (low platelet count), which is distinct from thrombocytosis [1]. *Venous thrombosis* - **Venous thrombosis**, particularly deep vein thrombosis (DVT) and pulmonary embolism (PE), is a hallmark feature of APS [2]. - The presence of **antiphospholipid antibodies** promotes a procoagulant state, leading to clot formation in veins. *Recurrent foetal loss* - **Recurrent foetal loss**, including miscarriages and stillbirths, is a classic obstetric manifestation of APS. - The antibodies interfere with placental function and blood supply, leading to pregnancy complications. *Neurological manifestations* - Various **neurological manifestations** are associated with APS, including stroke, transient ischemic attacks (TIAs), and cognitive dysfunction. - These are often due to **microthrombosis** in the cerebral vasculature or direct antibody effects.

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