Rheumatology and Immunology — MCQs

Rheumatology and Immunology Indian Medical PG Practice Questions and MCQs

Question 941: Which of the following statements about systemic sclerosis is correct?

A. Has a genetic predisposition component (Correct Answer)
B. Always leads to pulmonary arterial hypertension
C. Is always associated with anticentromere antibodies
D. Is characterized by calcinosis cutis in all patients

Explanation: ***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].

Question 942: Which of the following diseases is not a common cause of vasculitis in adults?

A. Giant cell arteritis
B. Polyarteritis nodosa
C. Kawasaki disease (Correct Answer)
D. Henoch-Schönlein purpura

Explanation: ***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.

Question 943: Which of the following is the difference between rheumatoid arthritis and osteoarthritis?

A. Osteophytes are seen in osteoarthritis
B. Systemic symptoms are seen in rheumatoid arthritis (Correct Answer)
C. Rheumatoid arthritis is common in hands and feet
D. Osteoarthritis is not an autoimmune disease

Explanation: 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.

Question 944: What condition is known to cause a false positive ELISA for HIV?

A. Multiple myeloma
B. Lepromatous leprosy
C. Systemic lupus erythematosus (SLE) (Correct Answer)
D. None of the listed conditions

Explanation: ***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].

Question 945: Which of the following is not associated with ankylosing spondylitis?

A. SLE (Correct Answer)
B. Reiter's syndrome
C. Crohn's disease
D. Psoriatic arthropathy

Explanation: ***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]

Question 946: 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?

A. Hemolytic uremic syndrome
B. Henoch-Schonlein purpura (Correct Answer)
C. Meningococcemia
D. Thrombotic thrombocytopenic purpura

Explanation: ***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.

Question 947: All of the following are true about Rheumatoid Arthritis, except which of the following?

A. Anemia
B. HLA-B27 is a marker for rheumatoid arthritis. (Correct Answer)
C. Subcutaneous nodules
D. HLA-DR determine genetic susceptibility

Explanation: ***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].

Question 948: Which condition is primarily associated with the presence of ANCA (Anti-Neutrophil Cytoplasmic Antibodies)?

A. Henoch-Schonlein Purpura
B. Rheumatoid arthritis
C. Goodpasture syndrome
D. Granulomatosis with Polyangiitis (GPA) (Correct Answer)

Explanation: ***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.

Question 949: Pleural effusion in rheumatoid arthritis is typically associated with the following features, except:

A. Glucose > 60 mg/dl (Correct Answer)
B. Protein > 3 gm/dl
C. Pleural fluid protein to serum protein ratio of >0.5
D. Pleural fluid LDH to serum LDH ratio of >0.6

Explanation: ***Glucose > 60 mg/dl*** - Pleural effusions in rheumatoid arthritis are classically characterized by **very low glucose levels** (often < 30 mg/dL), not elevated levels. [1] - This low glucose is attributed to impaired transport into the pleural space and increased consumption by inflammatory cells and bacteria. *Protein > 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.

Question 950: Which of the following is not typically associated with Reiter's syndrome?

A. Circinate balanitis
B. Oral ulcers
C. Keratoderma blenorrhagicum
D. Subcutaneous nodules (Correct Answer)

Explanation: ***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].

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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