Rheumatology and Immunology — MCQs
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Takayasu arteritis mainly affects?
Which condition is characterized by a Type 4 hypersensitivity reaction?
The most common organ to be involved in the acute phase of Graft vs host disease is?
Anti Jo-1 antibodies are a feature associated with?
In which condition is salivary scintigraphy particularly useful?
In patients with the limited cutaneous form of CREST syndrome, which autoantibody is most commonly found?
Which joint is most commonly affected in pseudogout?
Which of the following is NOT a major criterion in the Modified Jones Criteria for diagnosing Rheumatic Fever?
Tophi in gout are typically found in all regions except which of the following?
The most likely diagnosis in the case of a patient with multiple pulmonary cavities, hematuria, and red cell casts is?
Rheumatology and Immunology Indian Medical PG Practice Questions and MCQs
Question 871: Takayasu arteritis mainly affects?
- A. Pulmonary artery
- B. Celiac artery
- C. Subclavian artery (Correct Answer)
- D. Aorta
Explanation: ***Subclavian artery*** - **Takayasu arteritis** is a chronic inflammatory disorder that primarily affects the **aorta** and its **major branches**, including the subclavian arteries [1]. - Inflammation of the subclavian arteries can lead to **stenosis** or **occlusion**, resulting in symptoms such as **arm claudication**, **pulse deficit**, and blood pressure discrepancies between arms. *Pulmonary artery* - While Takayasu arteritis can, in rare cases, affect the pulmonary arteries, it is not their primary or most common target. - **Pulmonary artery involvement** is less frequent and generally seen in more widespread or severe disease. *Celiac artery* - The celiac artery, a branch of the aorta supplying the foregut, can be affected by **Takayasu arteritis**, but it is less commonly involved than the great vessels emanating from the aortic arch. - Involvement here can lead to symptoms like **abdominal pain** or **mesenteric ischemia**. *Aorta* - Takayasu arteritis primarily targets the **aorta** and its **proximal branches**, but "subclavian artery" is a more specific and common site of severe clinical manifestation often associated with the disease [1]. - The aorta itself is frequently affected, leading to **aneurysms**, **stenosis**, or **dilatation** throughout its course.
Question 872: Which condition is characterized by a Type 4 hypersensitivity reaction?
- A. Temporal arteritis (Correct Answer)
- B. Asthma
- C. Serum sickness
- D. Myasthenia gravis
Explanation: ***Temporal arteritis*** - This condition is also known as **giant cell arteritis** and is a classic example of a **Type 4 hypersensitivity reaction**, characterized by **T-cell mediated inflammation** of medium to large arteries [1]. - The inflammatory response is driven by activated **T lymphocytes** and **macrophages** infiltrating the arterial walls, leading to giant cell formation and pathology [1]. *Asthma* - **Asthma** is primarily mediated by a **Type 1 hypersensitivity reaction**, involving IgE antibodies and mast cell degranulation upon exposure to allergens. - This leads to immediate release of inflammatory mediators causing **bronchoconstriction** and airway inflammation. *Serum sickness* - **Serum sickness** is a **Type 3 hypersensitivity reaction**, caused by the formation of **immune complexes** (antigen-antibody complexes) that deposit in tissues and trigger inflammation [1]. - These immune complexes activate complement and recruit inflammatory cells, leading to symptoms like fever, rash, and arthralgia [1]. *Myasthenia gravis* - **Myasthenia gravis** is a **Type 2 hypersensitivity reaction**, where circulating **autoantibodies** target and block or destroy acetylcholine receptors at the neuromuscular junction [1]. - This destruction of receptors impairs nerve-to-muscle signaling, causing muscle weakness.
Question 873: The most common organ to be involved in the acute phase of Graft vs host disease is?
- A. Bone marrow
- B. Skin (Correct Answer)
- C. Liver
- D. Gut
Explanation: ***Skin*** - The **skin** is the **most frequently affected organ** in acute graft-versus-host disease (GVHD), with nearly all patients exhibiting some dermatologic manifestations. - Initial symptoms often include a **maculopapular rash** that can progress to erythroderma or bullous lesions. *Bone marrow* - While the bone marrow is the site of the **allogeneic stem cell transplant**, it is not typically considered an **acute target organ** for GVHD symptoms in the same way as the skin, gut, or liver. - Although the donor immune cells originate here, the manifestations of GVHD primarily affect other host tissues. *Liver* - The **liver** is a common organ involved in acute GVHD, often presenting with **elevated bilirubin** and alkaline phosphatase levels. - However, **liver involvement is less common** than skin involvement and typically occurs alongside or after skin manifestations. *Gut* - The **gastrointestinal tract** (gut) is frequently affected in acute GVHD, leading to symptoms like **diarrhea, nausea, vomiting**, and abdominal pain. - Similar to liver involvement, gut involvement is common but **occurs less frequently than skin involvement** as the primary acute manifestation.
Question 874: Anti Jo-1 antibodies are a feature associated with?
- A. Polymyositis (Correct Answer)
- B. Systemic sclerosis (scleroderma)
- C. Rheumatoid arthritis (RA)
- D. Systemic lupus erythematosus (SLE)
Explanation: Polymyositis - **Anti-Jo-1 antibodies** are a specific type of **anti-synthetase antibody** and are a key serological marker for polymyositis [1]. - Their presence often indicates a more severe form of the disease with a higher likelihood of **interstitial lung disease**, **Raynaud's phenomenon**, and **"mechanic's hands"** [1]. *Systemic sclerosis (scleroderma)* - While systemic sclerosis is also an **autoimmune connective tissue disease**, it is typically associated with antibodies such as **anti-Scl-70** (topoisomerase I) or **anti-centromere antibodies**. - **Anti-Jo-1 antibodies** are not characteristic of systemic sclerosis; their presence would suggest a different or overlapping diagnosis. *Rheumatoid arthritis (RA)* - **Rheumatoid arthritis** is primarily diagnosed by the presence of **rheumatoid factor (RF)** and **anti-cyclic citrullinated peptide (anti-CCP) antibodies**. - **Anti-Jo-1 antibodies** are not found in the typical serological profile of rheumatoid arthritis. *Systemic lupus erythematosus (SLE)* - **Systemic lupus erythematosus** is characterized by a wide array of autoantibodies, most notably **anti-nuclear antibodies (ANA)**, **anti-dsDNA antibodies**, and **anti-Sm antibodies** [2]. - **Anti-Jo-1 antibodies** are rarely, if ever, found in SLE and would point away from this diagnosis.
Question 875: In which condition is salivary scintigraphy particularly useful?
- A. Salivary gland tumors
- B. Sialolithiasis
- C. Sjogren syndrome (Correct Answer)
- D. Acute sialadenitis
Explanation: ***Sjogren syndrome*** - Salivary scintigraphy is highly useful in diagnosing **Sjogren syndrome** by assessing **salivary gland function**, specifically the uptake and excretion of the radiotracer. - In Sjogren syndrome, there is **reduced uptake** and **delayed excretion** of the tracer, reflecting the **exocrine gland dysfunction** characteristic of the autoimmune disease [1]. *Salivary gland tumors* - While salivary scintigraphy can sometimes show **"cold" or "hot" spots** corresponding to tumors, its primary role in tumor diagnosis is **limited**. - **MRI** and **CT scans**, along with **fine-needle aspiration biopsy**, are generally **more definitive** for characterizing salivary gland tumors. *Sialolithiasis* - **Sialolithiasis**, or salivary gland stones, is best diagnosed with **plain radiographs**, **ultrasound**, or **CT scans** which can directly visualize the calcifications within the ducts. - Salivary scintigraphy may show **obstruction** but does not directly identify the stone, making it **less specific** for this condition. *Acute sialadenitis* - **Acute sialadenitis** is typically diagnosed clinically based on **pain**, **swelling**, and **tenderness** of the salivary gland, often with purulent discharge from the duct. - Imaging like **ultrasound** or **CT** can help demonstrate inflammation or abscess formation, but scintigraphy is **not a primary diagnostic tool** for acute infection.
Question 876: In patients with the limited cutaneous form of CREST syndrome, which autoantibody is most commonly found?
- A. Anti-centromere antibodies (Correct Answer)
- B. Anti-DNA topoisomerase I
- C. Anti-double-stranded DNA antibodies
- D. Anti-Golgi antibodies
Explanation: ***Anti-centromere antibodies*** - **Anti-centromere antibodies (ACA)** are highly specific for the **limited cutaneous systemic sclerosis (lcSSc)**, often referred to as CREST syndrome. - They are associated with a milder course of the disease and a lower risk of serious internal organ involvement, especially **pulmonary fibrosis**. *Anti-DNA topoisomerase I* - **Anti-DNA topoisomerase I (Scl-70 antibodies)** are classically associated with the **diffuse cutaneous systemic sclerosis (dcSSc)**. - Patients with Scl-70 antibodies are at higher risk for **interstitial lung disease** and more generalized skin involvement. *Anti-double-stranded DNA antibodies* - **Anti-double-stranded DNA (anti-dsDNA) antibodies** are a hallmark of **systemic lupus erythematosus (SLE)**, not systemic sclerosis [1]. - Their presence often correlates with **lupus nephritis** and disease activity in SLE [1]. *Anti-Golgi antibodies* - **Anti-Golgi antibodies** are less commonly tested and are not specifically associated with systemic sclerosis or CREST syndrome. - They are sometimes found in various **autoimmune liver diseases** or in patients with certain neurological conditions.
Question 877: Which joint is most commonly affected in pseudogout?
- A. Knee (Correct Answer)
- B. Hip
- C. MP joint great toe
- D. MP joint thumb
Explanation: ***Knee*** - The **knee joint** is the most frequent site of acute attacks and chronic arthropathy in pseudogout due to the propensity for **calcium pyrophosphate dihydrate (CPPD)** crystal deposition in larger joints [1]. - Patients often present with acute, painful, and swollen knees, sometimes mimicking septic arthritis or gout [1]. *Hip* - While hip involvement can occur in pseudogout, it is **less common** than knee involvement and often manifests as chronic degenerative changes. - Acute hip flares are rarer compared to the knee. *MP joint great toe* - The **metatarsaophalangeal (MTP) joint of the great toe** is the classic site for **gout**, caused by monosodium urate crystal deposition. - Although pseudogout can affect various joints, this specific location is strongly indicative of gout, not pseudogout. *MP joint thumb* - The **metacarpophalangeal (MCP) joint of the thumb** can be affected in various arthropathies, but it is not the most commonly affected joint in pseudogout. - Involvement here is less specific for pseudogout compared to the knee.
Question 878: Which of the following is NOT a major criterion in the Modified Jones Criteria for diagnosing Rheumatic Fever?
- A. Erythema marginatum
- B. Carditis
- C. Chorea
- D. Polyarthalgia (Correct Answer)
Explanation: ***Polyarthralgia*** - **Polyarthralgia** is a **minor criterion** in the Modified Jones Criteria, indicating joint pain without objective signs of inflammation. - For a criterion to be considered major, it must involve objective signs of arthritis, which differentiate it from mere pain. [1] *Carditis* - **Carditis** is a **major criterion** and refers to inflammation of the heart, which can manifest as pericarditis, myocarditis, or endocarditis, often leading to valvular damage. [1] - It is one of the most serious manifestations of rheumatic fever and can lead to long-term cardiac complications. *Chorea* - **Sydenham chorea** (also known as St. Vitus' dance) is a **major criterion** characterized by involuntary, purposeless movements, primarily affecting the face, hands, and feet. [1] - It is a neurological manifestation reflecting central nervous system involvement and can appear late in the course of the disease. [1] *Erythema marginatum* - **Erythema marginatum** is a **major criterion** presenting as a distinctive, transient, non-pruritic rash with pink or red rings and clear centers, typically appearing on the trunk and proximal extremities. - This rash is a specific skin manifestation of acute rheumatic fever, though it is relatively uncommon.
Question 879: Tophi in gout are typically found in all regions except which of the following?
- A. Helix of ear
- B. Prepatellar bursae
- C. Synovial membrane
- D. Muscle (Correct Answer)
Explanation: ***Muscle*** - **Tophi** are crystalline deposits of **monosodium urate** that form in chronic gout [1]. They are typically found in cooler, less vascularized tissues, or tissues subjected to repetitive trauma. - While tophi can occur in many soft tissues, their presence **within muscle tissue is rare**, as muscle is well-vascularized and not a primary site for urate deposition [2]. *Prepatellar bursae* - The **prepatellar bursa** is a common site for tophi due to its superficial location and exposure to trauma. - Inflammation of the prepatellar bursa due to tophi accumulation is known as **"housemaid's knee"**. *Helix of ear* - The **helix of the ear** is a classic location for tophi due to its cooler temperature and poor vascularity, making it an ideal site for urate crystal deposition [1]. - These are often painless, subcutaneous nodules. *Synovial membrane* - The **synovial membrane** lining joints is a very common site for tophi formation, leading to destructive arthritis in chronic gout [2]. - Urate crystals in the synovial fluid provoke acute inflammatory attacks and can accumulate in the membrane over time.
Question 880: The most likely diagnosis in the case of a patient with multiple pulmonary cavities, hematuria, and red cell casts is?
- A. Anti-GBM disease
- B. Churg-Strauss
- C. Systemic lupus erythematousus
- D. Wegener's granulomatosis (Correct Answer)
Explanation: ***Wegener's granulomatosis (Granulomatosis with Polyangiitis)*** - This condition classically presents with a **triad of upper airway, lower airway, and renal involvement** [1]. **Pulmonary cavities** represent severe lung involvement, and **hematuria with red cell casts** indicate rapidly progressive glomerulonephritis [3]. - It is an **ANCA-associated vasculitis**, specifically associated with **c-ANCA (anti-PR3 antibodies)**, and often leads to **granulomatous inflammation** [1], [3]. *Anti-GBM disease* - Characterized by **glomerulonephritis** and **pulmonary hemorrhage** (Goodpasture's syndrome) [1], but does not typically cause multiple **pulmonary cavities**. - Diagnosed by the presence of **anti-glomerular basement membrane antibodies** and linear IgG deposition on renal biopsy [1]. *Churg-Strauss* - This condition, now known as **Eosinophilic Granulomatosis with Polyangiitis (EGPA)**, is characterized by **asthma, eosinophilia, and vasculitis** [1]. - While it can affect the lungs and kidneys, **pulmonary cavities** are less common, and severe eosinophilia is a hallmark, which is not mentioned here [1]. *Systemic lupus erythematosus* - A multisystem autoimmune disease that can cause **glomerulonephritis (lupus nephritis)** and pleuropulmonary involvement [2]. - However, **multiple pulmonary cavities** are not a typical manifestation, and other classic lupus features (e.g., malar rash, arthralgias) are absent in the description [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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