Rheumatology and Immunology Practice Questions

Q: Riedel's thyroiditis is associated with which of the following conditions?

Retroperitoneal fibrosis. ***Retroperitoneal fibrosis*** - **Riedel's thyroiditis** is a rare, chronic inflammatory condition characterized by the replacement of normal thyroid tissue with dense **fibrous tissue**. - It is often associated with other **fibrosing conditions**, including **retroperitoneal fibrosis**, sclerosing cholangitis, and orbital pseudotumor. *Hyperthyroidism* - **Riedel's thyroiditis** typically leads to **hypothyroidism** or euthyroidism, as the extensive fibrosis destroys thyroid tissue. - Hyperthyroidism is more commonly seen in conditions like **Graves' disease** or toxic nodular goiter. *Hyperparathyroidism* - **Hyperparathyroidism** is a disorder of the parathyroid glands leading to elevated calcium levels, and there is no direct association with **Riedel's thyroiditis**. - Riedel's thyroiditis primarily affects the thyroid gland and its surrounding structures. *Non-palpable thyroid gland* - **Riedel's thyroiditis** typically presents as a **hard, fixed, and often asymmetrical goiter** that can be easily palpated. - The fibrosis makes the gland very firm and usually causes local compressive symptoms.

Q: A 35-year-old woman complains of aching all over, with symptoms that have progressed over several years, and reports pain and weakness causing her to drop things. Physical examination reveals multiple points of tenderness over the neck, shoulders, elbows, and wrists, with no joint swelling or deformity. Laboratory tests, including complete blood count and ESR, are normal, and rheumatoid factor is negative. Which is the best therapeutic option for this patient?

Graded aerobic exercise. Graded aerobic exercise - This patient's symptoms (widespread aching, tenderness at multiple points, normal labs) are classic for fibromyalgia [1], [3]. - Graded aerobic exercise is a cornerstone of fibromyalgia treatment, improving pain, fatigue, and functional capacity [2]. Prednisone - Prednisone is a corticosteroid used for inflammatory conditions, but fibromyalgia is not primarily an inflammatory disease [3]. - Long-term use can lead to significant side effects without long-term improvement in fibromyalgia. Weekly methotrexate - Methotrexate is a disease-modifying antirheumatic drug (DMARD) used for inflammatory arthritides like rheumatoid arthritis, which is ruled out by the negative rheumatoid factor and absence of joint swelling [3]. - It has no proven efficacy for fibromyalgia and carries significant risks of toxicity. Hydroxychloroquine - Hydroxychloroquine is an antimalarial drug also used as a DMARD for conditions like lupus and rheumatoid arthritis. - It is not indicated for the treatment of fibromyalgia and would not address the patient's symptoms effectively.

Q: Which of the following best describes Mikulicz's disease?

An autoimmune condition.. An autoimmune disease - Mikulicz's disease is primarily characterized as an **autoimmune condition** affecting the **lacrimal and salivary glands**. - It is often associated with **Sjögren's syndrome**, leading to **xerostomia** (dry mouth) and **dry eyes**. *Neoplastic disease* - Mikulicz's disease is not classified as a neoplastic condition, which involves **abnormal cell growth** and tumors. - Unlike neoplasms, Mikulicz's disease does not exhibit **uncontrolled proliferation of cells**. *Viral infection* - It is not caused by any known **viral pathogens**, distinguishing it from conditions like **viral sialadenitis**. - Symptoms of Mikulicz's disease arise from **glandular dysfunction**, not direct **viral infection**. *An inflammatory disease* - While inflammation occurs, the primary etiology is autoimmune rather than purely inflammatory [1]. - It specifically involves **autoimmune-mediated damage** rather than being classified solely as an inflammatory process [1].

Q: In Familial Mediterranean fever, the gene encoding for which of the following proteins undergoes mutation?

Pyrin. ***Pyrin*** - Familial Mediterranean fever (FMF) is an **autoinflammatory disease** caused by mutations in the **MEFV gene**, which encodes the protein pyrin. - Pyrin plays a crucial role in regulating inflammation by modulating the **NLRP3 inflammasome**; mutations lead to uncontrolled inflammatory responses. *Transthyretin* - Mutations in the gene for **transthyretin** are associated with **hereditary amyloidosis**, particularly transthyretin amyloidosis (ATTR), which affects various organs. - This protein primarily functions in transporting **thyroid hormones** and **retinol**, and its misfolding leads to amyloid deposition, not FMF. *Perforin* - Mutations in the **perforin 1 gene (PRF1)** are linked to **familial hemophagocytic lymphohistiocytosis (HLH)**, a severe immunodeficiency disorder. - Perforin is a cytolytic protein crucial for T-cell and NK-cell mediated cytotoxicity, unrelated to FMF. *Immunoglobulin light chain* - Abnormal production or accumulation of **immunoglobulin light chains** is characteristic of **AL amyloidosis** (primary amyloidosis), where light chains misfold and deposit as amyloid fibrils. - This is a plasma cell dyscrasia and is not associated with the genetic cause of FMF.

Q: HLA-B27 is associated with:

Ankylosing spondylitis. ***Ankylosing spondylitis*** - **HLA-B27** is strongly associated with **ankylosing spondylitis** and other seronegative spondyloarthropathies [1]. - This gene is involved in the immune response and plays a role in the pathogenesis of the disease [1]. *Gouty arthritis* - **Gouty arthritis** is primarily caused by the deposition of **uric acid crystals** in joints, not by HLA-B27. - It is associated with **hyperuricemia**, dietary factors, and metabolic conditions. *Rheumatoid arthritis* - **Rheumatoid arthritis** is associated with **HLA-DR4** and **HLA-DR1**, and is characterized by the presence of rheumatoid factor (RF) and anti-CCP antibodies. - It is not directly linked to **HLA-B27**. *Systemic lupus erythematosus* - **Systemic lupus erythematosus (SLE)** is an autoimmune disease associated with a variety of genes, including **HLA-DR2** and **HLA-DR3**, and antinuclear antibodies (ANA) [2]. - It does not have a primary association with **HLA-B27**.

Q: Iliac crest involvement is common in which condition?

Ankylosing spondylitis. ***Ankylosing spondylitis*** - **Iliac crest involvement** is common due to inflammation at entheses (sites where tendons or ligaments insert into bone), which is a hallmark of **spondyloarthropathies** like ankylosing spondylitis [1]. - This involvement can manifest as **sacroiliitis**, which is a defining feature of the condition, affecting the joints immediately adjacent to the iliac crest [1]. *Rheumatoid arthritis* - Primarily affects the **synovial lining of joints**, typically small peripheral joints, and is not characterized by significant iliac crest involvement. - Does not primarily involve **enthesitis** or widespread inflammation of ligamentous attachments as seen in spondyloarthropathies. *Reiter's syndrome* - Also known as **Reactive Arthritis**, it is a seronegative spondyloarthropathy that can involve the sacroiliac joints and entheses, but **iliac crest involvement** is less specifically highlighted as a primary or common site compared to sacroiliitis. - While it shares some features with ankylosing spondylitis, the primary association with **iliac crest involvement** is more directly linked to chronic sacroiliitis seen in AS. *Osteoarthritis* - Characterized by **cartilage degeneration** and **bone spur formation**, typically in weight-bearing joints. - Does not primarily involve inflammation of entheses like the iliac crest, nor is it an inflammatory arthritis.

Q: Which of the following is NOT a characteristic feature of anaphylactic shock?

Pedal edema. ***Pedal edema*** - While **edema** can occur in anaphylaxis due to increased vascular permeability, **pedal edema** (swelling primarily in the lower extremities) is not a defining characteristic or a primary life-threatening feature of anaphylactic shock. - Anaphylactic shock primarily manifests with systemic symptoms like **hypotension**, **bronchospasm**, and widespread **urticaria** or **angioedema**, rather than isolated peripheral swelling [1], [3]. *Angioedema* - **Angioedema** is a common and often serious feature of anaphylaxis, involving swelling of deeper layers of the skin and mucous membranes [1]. - It can affect the **lips**, **face**, **throat**, and **airway**, potentially leading to airway obstruction [3]. *Urticarial rash* - An **urticarial rash**, or **hives**, is a hallmark cutaneous manifestation of anaphylaxis, characterized by itchy red welts [2]. - It is caused by the release of histamine and other mediators that increase capillary permeability, leading to fluid leakage into the skin [2], [3]. *Flushing* - **Flushing** is a common early symptom of anaphylaxis, characterized by sudden redness and warmth of the skin [1]. - It results from widespread **vasodilation** caused by mediator release, such as histamine [3].

Q: Decreased T cell immunity is a feature of what?

DiGeorge syndrome. ***Digeorge syndrome*** - Characterized by **thymic hypoplasia**, leading to a significant reduction in **T cell production** and function. - Patients commonly present with **recurrent infections** and associated features like **hypoparathyroidism** and cardiac defects. *Hyper IgM syndrome* - Causes **defective antibody class switching**, resulting in elevated **IgM** levels and low levels of other immunoglobulins, but **T cell counts can be normal** [1]. - The main defect is in **B cell activation**, not T cell immunity, hence not relevant to decreased T cell immunity [1]. *Severe congenital neutropenia* - Primarily presents with **recurrent bacterial infections** due to low levels of **neutrophils**, rather than T cell dysfunction. - This condition does not directly affect T cell immunity but rather focuses on the **myeloid lineage's impairment** in white blood cells. *Chronic granulomatous disease* - Involves defective **respiratory burst in phagocytes**, leading to issues in engulfing certain types of bacteria, primarily affecting **neutrophil function**. - T cell immunity remains largely intact, as this disorder does not primarily involve T cell deficiency or dysfunction.

Q: Which of the following statements is true regarding drug-induced lupus erythematosus (DILE)?

Antihistone antibodies are commonly found in DILE.. ***Antihistone antibodies are commonly found in DILE.*** - The presence of **antihistone antibodies** is a hallmark of drug-induced lupus erythematosus, detected in a majority of cases. - This antibody profile helps differentiate DILE from idiopathic systemic lupus erythematosus (SLE), where other autoantibodies like anti-dsDNA are more prominent. *CNS manifestations are common in DILE.* - **Central nervous system (CNS) involvement** is rare in DILE, distinguishing it from idiopathic SLE where neuropsychiatric symptoms are more prevalent. - While headaches and mild cognitive changes can occur, severe manifestations like seizures or psychosis are not typical of DILE. *Renal involvement is common in DILE.* - **Renal involvement**, such as glomerulonephritis, is highly uncommon in DILE, unlike idiopathic SLE where it is a significant cause of morbidity. - If significant renal disease is present in a patient suspected of DILE, it warrants a re-evaluation for idiopathic SLE or another diagnosis. *All patients with antibodies progress to systemic lupus erythematosus.* - Not all patients who develop antibodies, such as **antihistone antibodies**, will progress to full-blown DILE or systemic lupus erythematosus. - The condition typically resolves upon discontinuation of the offending drug, and the presence of antibodies alone is not sufficient for diagnosis, requiring clinical symptoms.

Q: What is the screening test for scleroderma?

Anti-nuclear antibody. ***Anti-nuclear antibody*** - **ANA** is the most sensitive **screening test** for systemic autoimmune diseases, including scleroderma [1]. - A positive ANA test indicates the presence of autoantibodies, leading to further, more specific testing for scleroderma. *U1-Ribonucleoprotein antibody* - This antibody is primarily associated with **mixed connective tissue disease (MCTD)**, not scleroderma as a screening test [1]. - It can be positive in other autoimmune diseases, but it is not the primary screening test for scleroderma. *Anti-LKM antibody* - **Anti-liver kidney microsomal (LKM) antibody** is predominantly found in **autoimmune hepatitis type 2**. - It has no role in the screening or diagnosis of scleroderma. *Anti-topoisomerase antibody* - This antibody, also known as **anti-Scl-70**, is **highly specific for diffuse systemic sclerosis** (scleroderma). - While specific, it is used as a confirmatory test once scleroderma is suspected, rather than a general screening test.

Question 1

Riedel's thyroiditis is associated with which of the following conditions?

Accepted Answer

Retroperitoneal fibrosis

Answer

Hyperthyroidism

Answer

Hyperparathyroidism

Answer

Non-palpable thyroid gland

Question 2

A 35-year-old woman complains of aching all over, with symptoms that have progressed over several years, and reports pain and weakness causing her to drop things. Physical examination reveals multiple points of tenderness over the neck, shoulders, elbows, and wrists, with no joint swelling or deformity. Laboratory tests, including complete blood count and ESR, are normal, and rheumatoid factor is negative. Which is the best therapeutic option for this patient?

Accepted Answer

Graded aerobic exercise

Answer

Prednisone

Answer

Weekly methotrexate

Answer

Hydroxychloroquine

Question 3

Which of the following best describes Mikulicz's disease?

Accepted Answer

An autoimmune condition.

Answer

A type of inflammatory disease.

Answer

A type of neoplastic disease.

Answer

A viral infection.

Question 4

In Familial Mediterranean fever, the gene encoding for which of the following proteins undergoes mutation?

Accepted Answer

Pyrin

Answer

Transthyretin

Answer

Perforin

Answer

Immunoglobulin light chain

Question 5

HLA-B27 is associated with:

Accepted Answer

Ankylosing spondylitis

Answer

Gouty arthritis

Answer

Rheumatoid arthritis

Answer

Systemic lupus erythematosus

Question 6

Iliac crest involvement is common in which condition?

Accepted Answer

Ankylosing spondylitis

Answer

Reiter's syndrome

Answer

Rheumatoid arthritis

Answer

Osteoarthritis

Question 7

Which of the following is NOT a characteristic feature of anaphylactic shock?

Accepted Answer

Pedal edema

Answer

Angioedema

Answer

Urticarial rash

Answer

Flushing

Question 8

Decreased T cell immunity is a feature of what?

Accepted Answer

DiGeorge syndrome

Answer

Hyper IgM syndrome

Answer

Severe congenital neutropenia

Answer

Chronic granulomatous disease

Question 9

Which of the following statements is true regarding drug-induced lupus erythematosus (DILE)?

Accepted Answer

Antihistone antibodies are commonly found in DILE.

Answer

CNS manifestations are common in DILE.

Answer

Renal involvement is common in DILE.

Answer

All patients with antibodies progress to systemic lupus erythematosus.

Question 10

What is the screening test for scleroderma?

Accepted Answer

Anti-nuclear antibody

Answer

U1-Ribonucleoprotein antibody

Answer

Anti-LKM antibody

Answer

Anti-topoisomerase antibody

Rheumatology and Immunology — MCQs

Rheumatology and Immunology — MCQs

On this page

Practice by Chapter

Want unlimited practice?