Rheumatology and Immunology Practice Questions

Q: Which of the following statements about systemic sclerosis is correct?

Has a genetic predisposition component. ***Has a genetic predisposition component*** - While not a simple Mendelian disorder, **systemic sclerosis** is known to have a **genetic predisposition**, with certain **HLA alleles** and other genes increasing susceptibility. - This genetic component interacts with environmental factors to trigger the disease in susceptible individuals. *Always leads to pulmonary arterial hypertension* - While **pulmonary arterial hypertension (PAH)** is a serious complication of systemic sclerosis, it does not occur in **all patients**; its prevalence varies depending on the disease subtype. - A significant percentage of patients, particularly those with the **limited cutaneous form**, can develop PAH, but it is not a 100% certainty. *Is always associated with anticentromere antibodies* - **Anticentromere antibodies (ACA)** are commonly found in patients with the **limited cutaneous form of systemic sclerosis** (CREST syndrome) but are not present in all patients. - Patients with the **diffuse cutaneous form** often test positive for **anti-Scl-70 (topoisomerase I) antibodies** or other autoantibodies. *Is characterized by calcinosis cutis in all patients* - **Calcinosis cutis**, the deposition of calcium salts in the skin, is a component of CREST syndrome (part of limited systemic sclerosis) but is **not present in all patients** with systemic sclerosis [1]. - Its presence varies, and it is more characteristic of the limited form rather than the diffuse form of the disease [1].

Q: Which of the following diseases is not a common cause of vasculitis in adults?

Kawasaki disease. ***Kawasaki diseases*** - Typically affects **children** rather than adults, making it an uncommon cause of vasculitis in the adult population [1]. - Characterized by **fever**, **rash**, and **cardiac complications**, but seldom seen in adults. *Poly arteritis nodosa* - A serious type of **vasculitis** affecting medium-sized arteries, commonly seen in adults [1]. - It can lead to complications such as **renal failure** and **intestinal ischemia**. *Giant cell arthritis* - Also known as **temporal arteritis**, it is a common vasculitis in adults that often presents with **headaches** and **jaw claudication**. - Associated with **polymyalgia rheumatica**, indicating vascular inflammation primarily in older adults. *Henoch-Schönlein purpura* - More common in **children**, but may occur in adults; it presents with **purpura**, **arthralgia**, and **abdominal pain** [2]. - Though less frequent, it is still occasionally considered in the differential diagnosis of adult vasculitis.

Q: Which of the following is the difference between rheumatoid arthritis and osteoarthritis?

Systemic symptoms are seen in rheumatoid arthritis. The original Explanation **Systemic symptoms are seen in rheumatoid arthritis** * **Rheumatoid arthritis** is a **systemic autoimmune disease** that can affect various organs beyond the joints, leading to symptoms like **fatigue**, **fever**, weight loss, and **rheumatoid nodules** [1]. * **Osteoarthritis** is a localized joint disease primarily affecting the cartilage and bone, and it typically **does not cause systemic symptoms** [1]. *Osteophytes are seen in osteoarthritis* * While **osteophytes** (bone spurs) are characteristic of **osteoarthritis**, their presence alone does not differentiate it from rheumatoid arthritis, as other conditions can also feature these [1]. * The primary differentiator lies in the underlying **pathophysiology** (degenerative vs. inflammatory) and the presence of systemic manifestations [1]. *Rheumatoid arthritis is common in hands and feet* * It is true that **rheumatoid arthritis** commonly affects the **small joints of the hands and feet**, often in a **symmetrical pattern** [1]. * However, this statement describes a common site of involvement rather than a fundamental difference in the **nature of the disease** or its systemic impact. *Osteoarthritis is not an autoimmune disease* * This statement is correct; **osteoarthritis is not an autoimmune disease**, but rather a **degenerative joint disease**. * While true, it describes what osteoarthritis **is not**, rather than a defining clinical difference in presentation or systemic involvement compared to rheumatoid arthritis.

Q: Which of the following is not associated with ankylosing spondylitis?

SLE. ***SLE*** - **Systemic lupus erythematosus (SLE)** is a systemic autoimmune disease characterized by a wide range of autoantibodies and multi-organ involvement, distinct from the primarily axial skeletal inflammation seen in ankylosing spondylitis. [1] - While both are autoimmune conditions, they have different genetic predispositions, clinical manifestations, and pathogenic mechanisms; **HLA-B27** is strongly associated with ankylosing spondylitis, whereas SLE is not. [1] *Reiter's syndrome* - **Reiter's syndrome**, now known as reactive arthritis, is a **seronegative spondyloarthropathy** that shares many features with ankylosing spondylitis, including **HLA-B27 association** and spinal involvement. [1] - It often follows a genitourinary or gastrointestinal infection and can present with **arthritis**, **urethritis**, and **conjunctivitis**, similar to other related spondyloarthropathies. [1] *Crohn's disease* - **Crohn's disease** is a type of inflammatory bowel disease (IBD) that has a well-established association with **spondyloarthropathies**, including ankylosing spondylitis. [1] - Approximately 5-10% of patients with Crohn's disease develop axial skeleton involvement, and both conditions share genetic predispositions, including **HLA-B27**. [1] *Psoriatic arthropathy* - **Psoriatic arthropathy** (also called psoriatic arthritis) is another **seronegative spondyloarthropathy** that frequently presents with axial skeleton involvement, similar to ankylosing spondylitis. [1] - It is closely linked to **psoriasis** and can manifest in various patterns including symmetrical polyarthritis, oligoarthritis, and sacroiliitis, often sharing common inflammatory pathways with ankylosing spondylitis. [1]

Q: What condition is known to cause a false positive ELISA for HIV?

Systemic lupus erythematosus (SLE). ***Systemic lupus erythematosus (SLE)*** - Patients with **SLE** can produce a variety of **autoantibodies**, some of which may cross-react with components of the HIV ELISA assay, leading to a false positive result [1]. - The immune dysregulation in SLE can cause **non-specific B-cell activation** and antibody production that confounds serological tests [1]. *Multiple myeloma* - This condition involves the uncontrolled proliferation of **plasma cells** and the overproduction of a single type of **monoclonal immunoglobulin** (M-protein). - While it can lead to various immune dysfunctions, it is not typically associated with false positive HIV ELISA results. *Lepromatous leprosy* - This severe form of leprosy is characterized by a **weak cell-mediated immune response** and high bacterial load, leading to widespread infection and hypergammaglobulinemia. - Though it involves substantial immune system changes, it is not a common cause of false positive HIV ELISA results. *None of the listed conditions* - This option is incorrect because **Systemic lupus erythematosus (SLE)** is a well-documented cause of false positive HIV ELISA results due to its complex autoimmune pathology [1].

Q: A 24-year-old female presents with abdominal pain, hematuria, and arthralgia. On examination, a palpable purpuric rash is seen on the trunk, limbs, and buttocks. Coagulation tests are normal. What is the most probable diagnosis?

Henoch-Schonlein purpura. ***Henoch-Schonlein purpura*** - The classic tetrad of **palpable purpura**, **abdominal pain**, **arthralgia**, and **renal involvement (hematuria)** is highly characteristic of Henoch-Schonlein Purpura (HSP) [1]. - Normal coagulation tests differentiate HSP from other coagulopathies, as it is a **leukocytoclastic vasculitis** mediated by IgA immune complexes [1]. *Hemolytic uremic syndrome* - This syndrome is characterized by a triad of **microangiopathic hemolytic anemia**, **thrombocytopenia**, and **acute kidney injury** [1]. - While it involves renal symptoms (hematuria), the presence of **palpable purpura** and **arthralgia** alongside normal coagulation tests makes HSP more likely. *Meningococcemia* - Typically presents with a **rapidly progressive non-blanching petechial or purpuric rash**, often associated with **fever**, **meningitis**, and **septic shock**. - Although it causes purpura, the patient does not exhibit signs of severe sepsis or meningitis; the specific constellation of abdominal pain, arthralgia, and hematuria points away from this diagnosis. *Thrombotic thrombocytopenic purpura* - Characterized by a pentad of **fever**, **thrombocytopenia**, **microangiopathic hemolytic anemia**, **neurological symptoms**, and **renal impairment** [1]. - While purpura can occur due to thrombocytopenia, the purpura is generally non-palpable, and the normal coagulation tests and lack of severe anemia make this less likely.

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

HLA-B27 is a marker for rheumatoid arthritis.. ***HLA-B27 is a marker for rheumatoid arthritis.*** - **HLA-B27** is a strong genetic marker primarily associated with **spondyloarthropathies**, such as **ankylosing spondylitis** and **reactive arthritis**, not rheumatoid arthritis [1]. - While it indicates a genetic predisposition to certain rheumatological conditions, it is not linked to the pathogenesis or diagnosis of rheumatoid arthritis. *HLA-DR determine genetic susceptibility* - **HLA-DR alleles**, particularly **HLA-DR4** and **HLA-DR1**, are strongly associated with genetic susceptibility to **rheumatoid arthritis** and often predict more severe disease. - These genes play a crucial role in antigen presentation to T-cells, contributing to the autoimmune response seen in RA. *Anemia* - **Anemia of chronic disease** is a common complication in patients with **rheumatoid arthritis**, often characterized by normal or elevated iron stores and reduced iron utilization [1]. - Inflammatory cytokines, such as **IL-6**, contribute to this type of anemia by affecting erythropoiesis and iron metabolism [1]. *Subcutaneous nodules* - **Subcutaneous nodules**, also known as **rheumatoid nodules**, are characteristic extra-articular manifestations of **rheumatoid arthritis**, typically found on extensor surfaces, such as the elbows or hands [1]. - These nodules are associated with more severe disease and are usually painless [1].

Q: Pleural effusion in rheumatoid arthritis is typically associated with the following features, except:

Glucose > 60 mg/dl. ***Glucose > 60 mg/dl*** - Pleural effusions in rheumatoid arthritis are classically characterized by **very low glucose levels** (often 3 gm/dl* - Rheumatoid pleural effusions are almost always **exudative**, meaning they have a high protein content, typically above 3 g/dL. [1] - This is due to increased vascular permeability and leakage of proteins into the pleural space from inflammation associated with RA. *Pleural fluid protein to serum protein ratio of >0.5* - An exudative effusion, characteristic of rheumatoid arthritis, is defined by a pleural fluid protein to serum protein ratio of **greater than 0.5**. [1] - This ratio indicates a significant protein leak into the pleural space, reflecting inflammation rather than just hydrostatic pressure changes. *Pleural fluid LDH to serum LDH ratio of >0.6* - Similar to protein, rheumatoid pleural effusions are exudative and exhibit a high pleural fluid LDH to serum LDH ratio, typically **greater than 0.6**. [1] - Elevated LDH in the pleural fluid reflects cellular breakdown and inflammation within the pleural space.

Q: Which condition is primarily associated with the presence of ANCA (Anti-Neutrophil Cytoplasmic Antibodies)?

Granulomatosis with Polyangiitis (GPA). ***Wegener's granulomatosis*** - ANCA (Antineutrophil cytoplasmic antibodies) are highly associated with Wegener's granulomatosis, manifesting as **granulomatous inflammation** of the lungs and kidneys. - Patients often have a positive **c-ANCA** with anti-PR3 antibodies, correlating with disease activity. *Goodpasture syndrome* - Primarily associated with **anti-glomerular basement membrane** antibodies affecting the kidneys and lungs, not ANCA. - Symptoms typically include **hemoptysis** and **renal failure**, distinguishing it from ANCA-associated vasculitides. *Henoch-Schonlein Purpura* - Characterized by **IgA vasculitis** leading to symptoms like purpura, abdominal pain, and renal involvement, but is not associated with ANCA. - Diagnosis relies on **skin biopsy** showing IgA deposits, contrasting with the ANCA profile in Wegener's. *Rheumatoid arthritis* - An autoimmune condition mainly involving **rheumatoid factor (RF)** [1] and anti-CCP antibodies, rather than ANCA. - Affects joints symmetrically and is marked by morning stiffness, which differs from the systemic vasculitis seen in ANCA-positive diseases.

Q: Which of the following is not typically associated with Reiter's syndrome?

Subcutaneous nodules. ***Subcutaneous nodules*** - **Subcutaneous nodules** are characteristic of conditions like **rheumatoid arthritis** [1] and **rheumatic fever**, not Reiter's syndrome (reactive arthritis). - While Reiter's syndrome can present with a variety of extra-articular manifestations, these specific nodules are not part of its typical clinical picture. *Oral ulcers* - **Oral ulcers** (painless aphthous ulcers) are a known mucocutaneous manifestation that can occur in patients with Reiter's syndrome [2]. - They are one of the 'can't see, can't pee, can't climb a tree' symptoms often associated with the condition, though less common than arthritis. *Keratoderma blenorrhagicum* - **Keratoderma blenorrhagicum** is a specific skin lesion characterized by hyperkeratotic, waxy, yellow-brown papules and plaques, predominantly on the palms and soles [2]. - It is highly characteristic, though not universally present, in patients with Reiter's syndrome and is clinically and histologically indistinguishable from pustular psoriasis. *Circinate balanitis* - **Circinate balanitis** is a painless inflammation of the glans penis characterized by shallow, serpiginous erosions [2]. - It is a common mucocutaneous manifestation of Reiter's syndrome, particularly in uncircumcised males [2].

Question 1

Which of the following statements about systemic sclerosis is correct?

Accepted Answer

Has a genetic predisposition component

Answer

Always leads to pulmonary arterial hypertension

Answer

Is always associated with anticentromere antibodies

Answer

Is characterized by calcinosis cutis in all patients

Question 2

Which of the following diseases is not a common cause of vasculitis in adults?

Accepted Answer

Kawasaki disease

Answer

Giant cell arteritis

Answer

Polyarteritis nodosa

Answer

Henoch-Schönlein purpura

Question 3

Which of the following is the difference between rheumatoid arthritis and osteoarthritis?

Accepted Answer

Systemic symptoms are seen in rheumatoid arthritis

Answer

Osteophytes are seen in osteoarthritis

Answer

Rheumatoid arthritis is common in hands and feet

Answer

Osteoarthritis is not an autoimmune disease

Question 4

Which of the following is not associated with ankylosing spondylitis?

Accepted Answer

SLE

Answer

Reiter's syndrome

Answer

Crohn's disease

Answer

Psoriatic arthropathy

Question 5

What condition is known to cause a false positive ELISA for HIV?

Accepted Answer

Systemic lupus erythematosus (SLE)

Answer

Multiple myeloma

Answer

Lepromatous leprosy

Answer

None of the listed conditions

Question 6

A 24-year-old female presents with abdominal pain, hematuria, and arthralgia. On examination, a palpable purpuric rash is seen on the trunk, limbs, and buttocks. Coagulation tests are normal. What is the most probable diagnosis?

Accepted Answer

Henoch-Schonlein purpura

Answer

Hemolytic uremic syndrome

Answer

Meningococcemia

Answer

Thrombotic thrombocytopenic purpura

Question 7

All of the following are true about Rheumatoid Arthritis, except which of the following?

Accepted Answer

HLA-B27 is a marker for rheumatoid arthritis.

Answer

Anemia

Answer

Subcutaneous nodules

Answer

HLA-DR determine genetic susceptibility

Question 8

Pleural effusion in rheumatoid arthritis is typically associated with the following features, except:

Accepted Answer

Glucose > 60 mg/dl

Answer

Protein > 3 gm/dl

Answer

Pleural fluid protein to serum protein ratio of >0.5

Answer

Pleural fluid LDH to serum LDH ratio of >0.6

Question 9

Which condition is primarily associated with the presence of ANCA (Anti-Neutrophil Cytoplasmic Antibodies)?

Accepted Answer

Granulomatosis with Polyangiitis (GPA)

Answer

Henoch-Schonlein Purpura

Answer

Rheumatoid arthritis

Answer

Goodpasture syndrome

Question 10

Which of the following is not typically associated with Reiter's syndrome?

Accepted Answer

Subcutaneous nodules

Answer

Circinate balanitis

Answer

Oral ulcers

Answer

Keratoderma blenorrhagicum

Rheumatology and Immunology — MCQs

Rheumatology and Immunology — MCQs

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