Rheumatology and Immunology Practice Questions

Q: Most characteristic feature of drug induced lupus

Anti histone antibody. Most characteristic feature of drug induced lupus ***Anti histone antibody*** - **Anti-histone antibodies** are present in 95% of patients with **drug-induced lupus (DIL)**, making them the most characteristic serological marker. - While other autoantibodies may be found, anti-histone antibodies are almost pathognomonic when DIL is suspected. *Rare anti-ds DNA* - **Anti-dsDNA antibodies** are characteristic of **systemic lupus erythematosus (SLE)** but are rarely found in DIL [1]. - Their absence helps differentiate DIL from SLE. *Renal involvement* - **Renal involvement** is common in **SLE** but is rare in DIL, with **nephritis** occurring in less than 5% of cases. - This clinical difference is important in distinguishing the two conditions. *All of the options* - This option is incorrect because **rare anti-dsDNA** and **rare renal involvement** are features that help *differentiate* DIL from SLE, rather than being characteristic features of DIL itself.

Q: A 26-year-old pregnant woman presents with arthritis and a malar rash that worsens with sun exposure. She has a low-grade fever and is admitted to the hospital. What is the likely diagnosis?

Systemic Lupus Erythematosus. ***Systemic Lupus Erythematosus*** - The combination of **arthritis**, **malar rash** that worsens with sun exposure (photosensitivity), and a **low-grade fever** in a young woman is highly characteristic of systemic lupus erythematosus (SLE) [1]. - SLE is an **autoimmune disease** with diverse clinical manifestations affecting multiple organ systems [1]. *Lyme disease* - Characterized by a **target-like rash (erythema migrans)**, which is distinct from a malar rash, and often presents with flu-like symptoms. - While Lyme disease can cause arthritis, the presence of a classic malar rash and photosensitivity points away from this diagnosis. *Chloasma* - Also known as the **"mask of pregnancy,"** chloasma is a common skin condition in pregnant women causing dark, discolored patches on the face. - It is a **pigmentation disorder** and does not involve arthritis, fever, or an associated malar rash that worsens with sun exposure. *Steven Johnsons syndrome* - An infrequent, serious systemic reaction to medication or infection, that triggers severe skin and mucous membrane reactions, typically presenting with **widespread blistering** and epidermal detachment. - This is an **acute, severe mucocutaneous reaction** and does not present with the chronic arthritis and photosensitive malar rash seen in this patient.

Q: ANA (antinuclear antibody) is seen in all except:

RA. ***RA*** - While ANA can be positive in a small percentage of RA patients, it is **not a characteristic feature** of rheumatoid arthritis and is found in only 30–50% of cases [1]. - The primary diagnostic markers for RA are **rheumatoid factor (RF)** and **anti-citrullinated protein antibody (ACPA)**. *Systemic sclerosis* - **Antinuclear antibodies (ANA)** are present in over 90% of patients with systemic sclerosis, often with specific patterns like nucleolar or centromere [1]. - This makes ANA a key diagnostic and classification criterion for the disease. *Sjogren's syndrome* - **ANA is positive in 80-90%** of patients with Sjögren's syndrome, making it a very common finding [1]. - Specific autoantibodies like anti-Ro (SSA) and anti-La (SSB) are also frequently present alongside ANA [1]. *SLE* - **ANA is highly sensitive for SLE**, being positive in over 95% of patients with systemic lupus erythematosus [1]. - A negative ANA virtually rules out SLE, making it a crucial screening test [2].

Q: Which of the following is not an extra-articular feature of Rheumatoid arthritis?

Proteinuria. ***Proteinuria*** - While kidney involvement can occur in RA (e.g., secondary amyloidosis, drug-induced nephropathy), **proteinuria** itself is not a direct or typical extra-articular feature of rheumatoid arthritis [1]. - It usually indicates a **complication** or secondary condition rather than a primary manifestation of RA. *Conjunctivitis* - **Sjögren's syndrome**, often associated with RA, can cause **dry eyes** (keratoconjunctivitis sicca), which may be described as conjunctivitis-like symptoms [1]. - **Episcleritis** and **scleritis** are also known ocular manifestations of RA, though less common than dry eyes [1]. *Pleural effusion* - **Rheumatoid pleurisy** leading to pleural effusion is a recognized extra-articular manifestation, often characterized by **low glucose levels** in the pleural fluid. - It can be symptomatic (e.g., chest pain, dyspnea) or asymptomatic. *Weight loss* - **Systemic inflammation** and the catabolic state associated with active RA can lead to generalized **fatigue** and **unintentional weight loss** [1]. - This is a common non-specific extra-articular symptom reflecting disease activity.

Q: Autoimmune diseases associated with Sjögren syndrome are all except?

Addison's disease. ***Addison's disease*** - While an **autoimmune disorder** itself (involving the adrenal glands), Addison's disease is generally **not directly associated** as a co-occurring autoimmune condition with Sjögren's syndrome. - Sjögren's syndrome is primarily characterized by **exocrine gland dysfunction**, specifically affecting lacrimal and salivary glands. *RA* - **Rheumatoid arthritis (RA)** is one of the most common autoimmune diseases found in association with **secondary Sjögren's syndrome**. - Sjögren's syndrome can occur in approximately **10-15% of patients with RA**, highlighting a strong pathogenic link. *SLE* - **Systemic lupus erythematosus (SLE)** frequently coexists with Sjögren's syndrome, often making it challenging to differentiate primary from secondary Sjögren's. - Both conditions share common **autoimmune mechanisms** and autoantibody profiles (e.g., anti-Ro/SSA and anti-La/SSB antibodies). *Mixed connective tissue disorder* - **Mixed connective tissue disease (MCTD)** is characterized by overlapping features of SLE, systemic sclerosis, and polymyositis, and also frequently includes features of **Sjögren's syndrome**. - The presence of **anti-U1-RNP antibodies** is a hallmark of MCTD, and these patients often experience sicca symptoms.

Q: Tophi in gout found in all regions except -

Muscle. Muscle - **Tophi** are typically composed of **monosodium urate crystals** deposited in poorly vascularized tissues [1]. - While muscle can be affected in severe, chronic gout, it is an **atypical location** for primary tophaceous deposits compared to other listed structures. *Joint capsule* - The **joint capsule** is a common site for tophi formation, given its proximity to the affected joints and relatively **poor blood supply** compared to fully vascularized tissues [2]. - Deposits here contribute to **joint destruction** and inflammation [3]. *Articular cartilage* - **Articular cartilage** is avascular and a frequent site for **urate crystal deposition**, contributing to the **erosive changes** seen in chronic gout [1]. - These deposits can lead to **chondrocalcinosis-like features** and progressive joint damage. *Skin* - **Tophi** commonly form in the **subcutaneous tissue** of the skin, especially around the ears, fingers, toes, and elbows [2]. - They appear as **firm, whitish nodules** and are a hallmark of chronic tophaceous gout [2].

Q: C.R.E.S.T syndrome is?

Limited scleroderma. ***Limited scleroderma*** - CREST syndrome is an acronym for **Calcinosis**, **Raynaud's phenomenon**, **Esophageal dysmotility**, **Sclerodactyly**, and **Telangiectasias**, which are the hallmark features of **limited cutaneous systemic sclerosis**. - Its clinical presentation is distinguished by skin thickening that affects only the **distal extremities** (below the elbows and knees) and the face. - This is the **most specific answer** as CREST syndrome is synonymous with limited scleroderma. *Localised scleroderma* - This typically presents as **morphea** or **linear scleroderma**, which are benign forms of scleroderma largely confined to the skin without systemic involvement. - It does not involve the characteristic internal organ manifestations or the full spectrum of features seen in CREST syndrome. *Generalised scleroderma* - This term is often synonymous with **diffuse cutaneous systemic sclerosis**, a more severe form where skin thickening extends to the trunk and proximal extremities. - It involves a higher risk of early and severe **internal organ involvement**, differentiating it from the more benign course of limited scleroderma. *Systemic sclerosis* - While CREST syndrome is technically a subtype of systemic sclerosis (specifically the limited cutaneous form), this option is **too broad** and does not specifically define what CREST syndrome represents. - Systemic sclerosis encompasses both **limited (CREST)** and **diffuse forms**, which have different prognoses and patterns of organ involvement. - "Limited scleroderma" is the more **precise and preferred answer** for CREST syndrome.

Q: In Raynaud's disease true is :

More common in female. ***More common in female*** - **Raynaud's phenomenon** is far more prevalent in **females**, particularly those between puberty and 40 years of age. - This **female predominance** is a key epidemiological feature, with an estimated female-to-male ratio as high as 9:1. *Sup. thrombophlebitis* - **Superficial thrombophlebitis** is the inflammation of a superficial vein due to a **blood clot**, which is not a typical manifestation or direct association of Raynaud's disease. - Raynaud's primarily involves **vasospasm** of small arteries, not thrombotic events in superficial veins. *Lower limb more commonly involved than upper limb* - **Raynaud's phenomenon** predominantly affects the **fingers and toes** (acral parts), with **upper limbs** being more commonly involved than the lower limbs, or at least equally, but not less. - Involvement of the **fingers** is the hallmark of the condition. *Associated with migraine* - While both **migraine** and **Raynaud's phenomenon** involve **vascular dysfunction** and are more prevalent in women, a direct, consistent, and causal association is not definitively established as a defining characteristic of Raynaud's disease itself. - Some studies suggest a higher comorbidity, but it isn't a universally true defining feature.

Q: Specific antibody for SLE is -

Anti ds DNA. ***Anti ds DNA*** - **Anti-dsDNA antibodies** are highly specific for **Systemic Lupus Erythematosus (SLE)** and are included in the diagnostic criteria. [1] - Their presence often correlates with **disease activity**, particularly with lupus nephritis. [1] *Anti-La* - **Anti-La (SS-B) antibodies** are primarily associated with Sjögren's Syndrome, though they can also be seen in SLE. [1] - They are considered a more specific marker for **Sjögren's Syndrome** than for SLE. *Anti-Jo* - **Anti-Jo-1 antibodies** are characteristic of **polymyositis** and dermatomyositis, particularly associated with interstitial lung disease in these conditions. - They are not typically found in SLE and are not a diagnostic marker for the disease. *Anti-Ro* - **Anti-Ro (SS-A) antibodies** are commonly found in Sjögren's Syndrome and are also associated with **subacute cutaneous lupus erythematosus (SCLE)** and neonatal lupus. [1] - While present in a significant percentage of SLE patients, they are not as specific as anti-dsDNA antibodies for the diagnosis of SLE itself. [1]

Q: Which one of the following conditions is not associated with rheumatoid arthritis? (If all are associated, select 'None').

None of the options. ***None of the options*** - All listed conditions—**cricoarytenoid arthritis**, **pleural effusion**, and **pulmonary hypertension**—are recognized extra-articular manifestations or complications of **rheumatoid arthritis (RA)** [1]. - Rheumatoid arthritis is a systemic inflammatory disease that can affect multiple organ systems beyond the joints. *Cricoarytenoid arthritis* - This condition involves inflammation of the **cricoarytenoid joint** in the larynx, leading to **hoarseness**, stridor, or even airway obstruction. - It is a known, though less common, upper airway manifestation of **rheumatoid arthritis**. *Pleural effusion* - **Rheumatoid pleuritis** commonly presents as a **pleural effusion**, often unilateral [1]. - Analysis of **rheumatoid pleural fluid** typically shows low glucose, high LDH, and sometimes rheumatoid factor. *Pulmonary hypertension* - **Pulmonary hypertension** in RA can result from various mechanisms, including **interstitial lung disease**, vasculitis, or chronic thromboembolism [1]. - It is a serious complication associated with increased morbidity and mortality in **rheumatoid arthritis** patients.

Question 1

Most characteristic feature of drug induced lupus

Accepted Answer

Anti histone antibody

Answer

Rare anti-ds DNA

Answer

Renal involvement

Answer

All of the options

Question 2

A 26-year-old pregnant woman presents with arthritis and a malar rash that worsens with sun exposure. She has a low-grade fever and is admitted to the hospital. What is the likely diagnosis?

Accepted Answer

Systemic Lupus Erythematosus

Answer

Lyme disease

Answer

Chloasma

Answer

Steven Johnsons syndrome

Question 3

ANA (antinuclear antibody) is seen in all except:

Accepted Answer

RA

Answer

Systemic sclerosis

Answer

Sjogren's syndrome

Answer

SLE

Question 4

Which of the following is not an extra-articular feature of Rheumatoid arthritis?

Accepted Answer

Proteinuria

Answer

Conjunctivitis

Answer

Pleural effusion

Answer

Weight loss

Question 5

Autoimmune diseases associated with Sjögren syndrome are all except?

Accepted Answer

Addison's disease

Answer

RA

Answer

SLE

Answer

Mixed connective tissue disorder

Question 6

Tophi in gout found in all regions except -

Accepted Answer

Muscle

Answer

Joint capsule

Answer

Articular cartilage

Answer

Skin

Question 7

C.R.E.S.T syndrome is?

Accepted Answer

Limited scleroderma

Answer

Localised scleroderma

Answer

Generalised scleroderma

Answer

Systemic sclerosis

Question 8

In Raynaud's disease true is :

Accepted Answer

More common in female

Answer

Sup. thrombophlebitis

Answer

Lower limb more commonly involved than upper limb

Answer

Associated with migraine

Question 9

Specific antibody for SLE is -

Accepted Answer

Anti ds DNA

Answer

Anti-La

Answer

Anti-Jo

Answer

Anti-Ro

Question 10

Which one of the following conditions is not associated with rheumatoid arthritis? (If all are associated, select 'None').

Accepted Answer

None of the options

Answer

Cricoarytenoid arthritis

Answer

Pleural effusion

Answer

Pulmonary hypertension

Rheumatology and Immunology — MCQs

Rheumatology and Immunology — MCQs

On this page

Practice by Chapter

Want unlimited practice?