Rheumatology and Immunology — MCQs

A 20-year-old female has an erythematous rash over her face, including both cheeks and the bridge of her nose, which is exacerbated by sunlight exposure when she is outdoors. In addition to the rash, she has experienced muscle and joint pain for several months. Although radiographs of the joints do not reveal any abnormalities, she has normal joint mobility without deformity. Which laboratory test finding is most characteristic of systemic lupus erythematosus (SLE)?

Q956

In ankylosing spondylitis, joint involvement is least in?

Q957

A person presents with recurrent swelling on the face and lips due to emotional stress. The likely cause is?

Q958

All of the following are true about Drug-Induced Lupus in comparison to Idiopathic SLE, except:

Q959

Normal CRP with elevated ESR is seen in:

Q960

Which type of arthritis is commonly associated with tarsal tunnel syndrome?

Rheumatology and Immunology Indian Medical PG Practice Questions and MCQs

Question 951: Which is the rheumatoid arthritis autoantibody?

A. Anti DLE
B. Anti CCP (Correct Answer)
C. Anti ds DNA
D. Anti histone

Explanation: ***Anti CCP*** - **Anti-Citrullinated Protein Antibodies (CCP)** are highly specific for **rheumatoid arthritis** and are used for diagnosing this condition. - A positive **Anti-CCP** test can indicate the presence of **rheumatoid arthritis** even before clinical symptoms appear. *Anti histone* - This antibody is primarily associated with **drug-induced lupus erythematosus**, not rheumatoid arthritis. - It identifies a **response** to medications, rather than being a specific marker for a rheumatic condition like RA. *Anti DLE* - Suggests antibodies related to **discoid lupus erythematosus**, not rheumatoid arthritis. - These antibodies do not correlate with inflammatory joint disease or diagnosis of RA. *Anti ds DNA* - Commonly associated with **systemic lupus erythematosus** (SLE) rather than rheumatoid arthritis [1]. - While relevant for lupus, it lacks specificity for diagnosing rheumatic arthritis; ANA testing is noted as not useful in diagnosing RA specifically [1].

Question 952: Which of the following conditions is least likely to present with polyarticular involvement in clinical practice?

A. Psoriatic arthritis
B. SLE
C. Gout
D. Ankylosing spondylitis (Correct Answer)

Explanation: ***SLE*** - Systemic lupus erythematosus (SLE) is a **systemic autoimmune disease** and while it can present with polyarthritis, other systemic features also occur, making it less common in isolation [1]. - It encompasses a broad spectrum of **clinical manifestations**, often leading to multi-organ involvement beyond joint symptoms [1]. *Gout* - Usually triggers **acute inflammatory arthritis**, characterized by sudden and severe pain in a single joint, particularly the big toe [2]. - It is significantly common and frequently treated in clinical practice. *Ankylosing spondylitis* - Primarily affects the spine and sacroiliac joints, causing stiffness and is quite an **identifiable form of inflammatory arthritis** [3]. - It has a notable association with **HLA-B27** and can present with back pain, making it relatively common among spondyloarthropathies [3]. *Psoriatic arthritis* - Associated with **psoriasis**, this form of arthritis can occur and is known for **asymmetrical polyarthritis** and dactylitis [4]. - It is a recognized inflammatory condition that leads to joint destruction and is increasingly prevalent among patients with skin involvement [4].

Question 953: Most common pulmonary manifestation of SLE is which of the following?

A. Shrinking Lung
B. Pleuritis (Correct Answer)
C. Interstitial inflammation
D. Intra alveolar hemorrhage

Explanation: ***Pleuritis*** - **Pleuritis** and **pleural effusions** are the most common pulmonary manifestations in patients with SLE, affecting up to 50% of patients [1]. - They often present with **pleuritic chest pain** and can be diagnosed via chest X-ray or CT scan [1]. *Shrinking Lung* - **Shrinking lung syndrome** is a rare but severe manifestation characterized by decreased lung volumes and an elevated diaphragm, but it is not the most common [1]. - Its pathogenesis is unclear, but it may involve phrenic neuropathy, diaphragmatic myopathy, or chronic pleuritis with fibrosis [1]. *Intra alveolar hemorrhage* - **Diffuse alveolar hemorrhage** is a life-threatening complication of SLE, leading to acute respiratory failure and hemoptysis, but it is uncommon [1]. - It often requires aggressive immunosuppressive therapy due to its high mortality rate [1]. *Interstitial inflammation* - **Interstitial lung disease** (ILD) in SLE, manifesting as interstitial inflammation or fibrosis, is a less common pulmonary complication compared to pleuritis [1]. - While it can lead to progressive dyspnea and cough, it usually develops in a chronic course [1].

Question 954: Bilateral hilar lymphadenopathy, along with non-caseating granulomas, is a characteristic feature of:

A. Sarcoidosis (Correct Answer)
B. Scleroderma
C. SLE
D. Stein-leventhal syndrome

Explanation: ***Sarcoidosis*** - This autoimmune disease is characterized by the formation of **non-caseating granulomas** in various organs, most commonly the lungs and lymphatic system. - **Bilateral hilar lymphadenopathy** is a classic radiographic finding, seen in up to 90% of cases, often accompanied by interstitial lung disease [1]. *Scleroderma* - Characterized by **fibrosis** of the skin and internal organs, leading to hardening and thickening of tissues. - Does not typically present with bilateral hilar lymphadenopathy or non-caseating granulomas. *SLE* - An autoimmune disease characterized by a wide array of symptoms affecting multiple organ systems, including arthritis, skin rashes, and kidney problems. - While it can manifest with lung involvement, such as pleuritis or interstitial lung disease, it does not typically involve **non-caseating granulomas** or classic hilar lymphadenopathy. *Stein-Leventhal syndrome* - Also known as **polycystic ovary syndrome (PCOS)**, it is an endocrine disorder characterized by hormonal imbalances, irregular periods, and androgen excess. - This syndrome is entirely unrelated to bilateral hilar lymphadenopathy or the formation of granulomas.

Question 955: A 20-year-old female has an erythematous rash over her face, including both cheeks and the bridge of her nose, which is exacerbated by sunlight exposure when she is outdoors. In addition to the rash, she has experienced muscle and joint pain for several months. Although radiographs of the joints do not reveal any abnormalities, she has normal joint mobility without deformity. Which laboratory test finding is most characteristic of systemic lupus erythematosus (SLE)?

A. Elevated anti-streptolysin 0 (ASO) titer
B. HLA-B27 genotype
C. Markedly decreased serum level of immunoglobulin G (IgG)
D. Antibodies to double-stranded DNA (Correct Answer)

Explanation: A 20-year-old female has an erythematous rash over her face, including both cheeks and the bridge of her nose, which is exacerbated by sunlight exposure [1]. In addition to the rash, she has experienced muscle and joint pain for several months. Although radiographs of the joints do not reveal any abnormalities, she has normal joint mobility without deformity. Which laboratory test finding is most characteristic of systemic lupus erythematosus (SLE)? ***Antibodies to double-stranded DNA*** - In **systemic lupus erythematosus (SLE)** [2], which fits the description, the presence of **anti-double-stranded DNA antibodies** is a hallmark finding. - This antibody is associated with **renal involvement** and correlates with disease activity, making it a critical laboratory finding [2]. *Elevated anti-streptolysin 0 (ASO) titer* - This test indicates recent **streptococcal infection**, not related to the symptoms or autoimmune features of SLE. - It is mainly used in the context of **rheumatic fever** and **post-streptococcal glomerulonephritis**. *Markedly decreased serum level of immunoglobulin G (IgG)* - Decreased IgG levels do not specifically indicate **SLE**, which often shows **increased overall immunoglobulin levels** due to chronic inflammation. - Hypogammaglobulinemia can occur in various conditions but is not characteristic of lupus. *HLA-B27 genotype* - This genotype is primarily associated with **spondyloarthropathies** (e.g., ankylosing spondylitis), not systemic lupus erythematosus [2]. - It is not relevant to the **cutaneous symptoms** or the autoimmune nature of the presented disease.

Question 956: In ankylosing spondylitis, joint involvement is least in?

A. Costochondral junction
B. Sacroiliac joint
C. Wrist and hand (Correct Answer)
D. Acromio-clavicular joint

Explanation: Detailed explanation of joint involvement in ankylosing spondylitis: ***Wrist and hand*** - **Ankylosing spondylitis (AS)** primarily affects the **axial skeleton** (spine, sacroiliac joints) and **large peripheral joints** like the hips and shoulders. - Involvement of the small joints of the **wrist and hand** is uncommon [1] and usually occurs late in the disease course, making it the least involved area among the options. *Sacroiliac joint* - The **sacroiliac joints** are almost universally affected in AS, often being the **first joints** to show inflammation [2]. - Inflammatory changes and eventual **fusion** of these joints are hallmarks of the disease [2]. *Costochondral junction* - Involvement of the **costochondral junctions** can lead to **chest wall pain** and stiffness, contributing to the typical "bamboo spine" appearance and reduced chest expansion in AS [2]. - This is a common extra-axial manifestation of the disease, contributing to respiratory compromise. *Acromio-clavicular joint* - The **acromio-clavicular joints** can be affected in AS, causing pain and restricted movement in the shoulder girdle [1]. - This is considered a common site of **peripheral enthesitis** and articular involvement in AS [1].

Question 957: A person presents with recurrent swelling on the face and lips due to emotional stress. The likely cause is?

A. C1 esterase inhibitor deficiency (Correct Answer)
B. Allergy
C. Anaphylaxis
D. ACE inhibitor-induced angioedema

Explanation: C1 esterase inhibitor deficiency - This condition presents with recurrent episodes of angioedema (swelling of face, lips, airway, or gastrointestinal tract) that are often triggered by stress, trauma, or medical procedures. - The deficiency leads to unregulated activation of the complement and kallikrein-kinin pathways, resulting in excessive bradykinin production which causes increased vascular permeability and swelling. Allergy - Allergic reactions typically involve hives (urticaria) and itching, which are usually absent in C1 esterase inhibitor deficiency. - Allergic angioedema is often mediated by histamine and resolves with antihistamines or epinephrine, which are ineffective in C1 esterase inhibitor deficiency [2]. Anaphylaxis - Anaphylaxis is a severe, life-threatening allergic reaction that includes symptoms such as respiratory distress, hypotension, and generalized urticaria, in addition to angioedema [2]. - While angioedema can be a feature, the constellation of symptoms and the common triggers differ significantly from C1 esterase inhibitor deficiency [2]. ACE inhibitor-induced angioedema - This type of angioedema is a known side effect of ACE inhibitor medications and usually occurs after beginning the medication [1]. - It is also caused by increased bradykinin levels but is directly linked to the drug's action, not an underlying genetic deficiency, and typically resolves upon discontinuation of the medication.

Question 958: All of the following are true about Drug-Induced Lupus in comparison to Idiopathic SLE, except:

A. More common in females (Correct Answer)
B. Hypocomplementemia is less common
C. Milder disease
D. Presence of renal or CNS disease is rare

Explanation: ***More common in females*** - This statement is **false** for drug-induced lupus (DIL). While **idiopathic SLE** has a significant female predominance, DIL shows a **more even gender distribution** or a slightly higher incidence in males depending on the drug [1]. - Thus, DIL being *more common in females* compared to idiopathic SLE is incorrect; it is actually less pronounced. *Milder disease* - Drug-induced lupus (DIL) is generally characterized by a **milder clinical course** compared to idiopathic SLE. - Symptoms often resolve following cessation of the offending drug. *Presence of renal or CNS disease is rare* - **Major organ involvement**, such as severe **renal** (nephritis) or **central nervous system (CNS)** disease, is rare in drug-induced lupus. - These severe manifestations are characteristic of idiopathic SLE [1]. *Hypocomplementemia is less common* - **Hypocomplementemia** (low C3 and C4 levels) is a common finding in active idiopathic SLE, reflecting immune complex activity. - In contrast, **drug-induced lupus** typically presents with normal complement levels.

Question 959: Normal CRP with elevated ESR is seen in:

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

Explanation: ***SLE*** - In **Systemic Lupus Erythematosus (SLE)**, the **ESR** is often significantly elevated due to hypergammaglobulinemia and increased fibrinogen, reflecting systemic inflammation [2]. - However, the **CRP** may be normal or only mildly elevated, which is a distinguishing feature compared to other inflammatory conditions [1], [2]. *RA* - In **Rheumatoid Arthritis (RA)**, both **CRP and ESR** are typically elevated, reflecting the acute phase response due to active inflammation. - An isolated elevated ESR with a normal CRP is less common in active RA and would prompt consideration of alternative or co-existing conditions. *Scleroderma* - For **Scleroderma (Systemic Sclerosis)**, the **ESR and CRP** are often normal or only mildly elevated, even in the presence of extensive organ involvement [1]. - Significant elevations in both ESR and CRP should prompt a search for alternative diagnoses or complications such such as an infection. *Polymyalgia rheumatica* - **Polymyalgia Rheumatica (PMR)** is characterized by marked inflammation, leading to a **significantly elevated ESR and CRP** [2]. - A normal CRP with an elevated ESR would be atypical for PMR, which is primarily diagnosed based on clinical symptoms and this distinct inflammatory marker pattern.

Question 960: Which type of arthritis is commonly associated with tarsal tunnel syndrome?

A. Ankylosing spondylitis
B. Osteoarthritis
C. Rheumatoid arthritis (Correct Answer)
D. Psoriatic arthritis

Explanation: Rheumatoid arthritis (RA) is a systemic inflammatory disease that can lead to synovitis and inflammation of tendons, which can compress the posterior tibial nerve in the tarsal tunnel [1]. The chronic inflammation and proliferation of the synovial tissue around the ankle can directly impinge on the nerve, causing tarsal tunnel syndrome [1]. *Ankylosing spondylitis* - This is a chronic inflammatory disease primarily affecting the axial skeleton, particularly the spine and sacroiliac joints. - While it can have peripheral manifestations, it does not typically cause tarsal tunnel syndrome through direct nerve compression from inflammation in the ankle joint. *Osteoarthritis* - Osteoarthritis (OA) is a degenerative joint disease characterized by cartilage breakdown and bone spur formation. - While OA can affect the ankle, it is less directly associated with the inflammatory changes that lead to tarsal tunnel syndrome compared to RA. *Psoriatic arthritis* - Psoriatic arthritis (PsA) is an inflammatory arthritis associated with psoriasis, often involving joints of the hands, feet, and spine. - Although PsA can cause inflammation in the foot and ankle, it is not as commonly linked to tarsal tunnel syndrome as rheumatoid arthritis.

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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