29-11-2023

MEDICINE CHALLENGE DAY

-3
1. Which of the following is not an autoimmune disease?
a. SLE
b. Grave's disease
c. Ulcerative Colitis
d. Rheumatoid Arthritis
Ans. (c) Ulcerative Colitis
2. Anti Ro bodies are present in all EXCEPT:
a. SLE
b. Sjogren syndrome
c. Neonatal lupus
d. Mixed connective tissue disorder
Ans.(d) Mixed connective tissue disorder
• Anti-Rho or SS-A antibodies are seen in SLE, Sjogren
syndrome and can be transmitted across the placenta
resulting in neonatal lupus which presents as complete
heart block.
• Mixed connective tissue disorder is associated with U1
R.N.P. (Ribo-Nucleo-protein antibody).
3. Normal CRP with elevated ESR is seen in?
a. RA
b. SLE
c. Scleroderma
d. Polymyalgia rheumatica
Ans. (b) SLE
High ESR with normal CRP
1. SLE
2. Giant cell arteritis
3. Multiple myeloma
4. Leukemia
5. Ulcerative colitis
4. Characteristic Cardiac lesion in SLE is:
a. Verrucous endocarditis
b. Valvular incompetence
c. Heart block
d. Myocardial fibrosis
Ans. (a) Verrucous endocarditis
• Libman-Sacks endocarditis (otherwise known as
verrucous, marantic, or nonbacterial thrombotic
endocarditis) is the most characteristic cardiac
manifestation of the autoimmune disease systemic Lupus
erythematosus.
• The most common valve affected is mitral and then aortic,
though all are involved.
5. A young girl is admitted with joint pains and a butterfly rash and positive urine
proteinuria. The best test for her diagnosis is?
a. Anti <ds-DNA antibody
b. Anti-centromere antibody
c. Antibodies to RNP
d. Antibodies to tRNA synthetase
Ans. (a) Anti ds-DNA antibody
• Anti ds-DNA antibody is associated with increased risk of
nephritis in cases of SLE.
• Anti centromere ab is associated with limited scleroderma.
• Antibodies to Ribosomal-Pantigen is associated with CNS
lupus.
• Antibodies to tRNA synthetase are associated with,
polymyositis with interstitial lung disease.
6. Psychosis in SLE is caused by:
a. Anti-ribosomal P antibody
b. Anti-glutamate acid decarboxylase antibody
c. Anti-endomyosial antibody
d. Anti-histone antibody
Ans. (a) Anti-ribosomal P antibody
7. Most common presentation of cardiac lupus?
a. Myocarditis
b. Pericarditis
c. Aortic regurgitation
d. Libman sacks endocarditis
Ans. (b) Pericarditis
• Pericarditis is the most common cardiac abnormality in
systemic lupus erythematosus (SLE) patients, but lesions of
the valves, myocardium and coronary vessels may all occur.
• In the past, cardiac manifestations were severe and life
threatening, often leading to death. Echocardiography is a
sensitive and specific technique in detecting cardiac
abnormalities, particularly mild pericarditis, valvular lesions
and myocardial dysfunction.
• Therefore, echocardiography should be performed periodically in
SLE patients. Vascular occlusion, including coronary arteries, may
develop due to vasculitis, premature athero-sclerosis or anti-
phospholipid antibodies associated with SLE. Premature
atherosclerosis is the most frequent cause of coronary artery
disease (CAD) in SLE patients.
8. The following are features of SLE except:
a. Sterile Vegetations on valve cusps
b. Raynaud's phenomenon
c. Atherosclerosis
d. Pulmonary fibrosis
Ans. (d) Pulmonary fibrosis
• Shrinking lung syndrome is a feature of SLE but it is
characterized by diaphragmatic myopathy leading to appearance
of small lungs radiologically.
• Pulmonary fibrosis is not seen in SLE.
• Premature atherosclerosis is a recognized feature of secondary
anti-phospholipid syndrome. The Vegetations in Libman sacks
endocarditis are sterile and seen on inferior surface of valve
cups.
9. Lupus anti-coagulant is associated with all except:
a. Recurrent abortion
b. Polyhydramnios
c. Intrauterine growth retardation
d. Pre-eclampsia-early onset
Ans. (b) Polyhydramnios
• Anti-phospholipid antibodies are often but not always associated
with adverse obstetric outcomes, including first trimester
miscarriage, mid-trimester and later fetal loss, intrauterine death
and stillbirth. However, the risk of pregnancy loss is greatest
during the mid-trimester.
• Diagnostic criteria for APLS include:
1. Unexplained deaths of a morphologically normal fetus
( documented by ultrasound or direct examination of the fetus) at
or beyond the 10th week of gestation
2. Three or more unexplained consecutive spontaneous abortions
before the 10th week of gestation, with maternal anatomic or
hormonal abnormalities and paternal and maternal chromosomal
causes excluded
3. At least 1 premature birth of a morpho-logically normal neonate
before the 34th week of gestation due to eclampsia or severe pre-
eclampsia according to standard definitions, or recognized
features of placental insufficiency.
10. All of the following are indicators for the use of corticosteroids in SLE except:
a. Neuropsychiatric lupus
b. Pericarditis
c. Endocarditis
d. Nephritic syndrome
Ans. (c) Endocarditis
• The pericardial friction rub of pericarditis resolves with steroids.
• Lupus cerebritis and lupus nephritis responds to steroids.
• No specific therapy is indicated for Libman-Sacks endocarditis.
Valve surgery may be required for hemodynamically significant
valvular dysfunction. Mechanical prostheses are usually implanted
Manage heart failure due to valvular dysfunction according to usual
guidelines. Medications may include vasodilators, beta blockers,
diuretics, and digoxin
11. Corticosteroids are used in all except:
a. Lupus nephritis
b. Lupus cerebritis
c. Libman sacks endocarditis
d. Lupus pernio
Ans. (c) Libman Sacks
Endocarditis
No specific therapy is indicated for Libman-Sacks
endocarditis. Manage heart failure due to valvular
dysfunction according to usual guidelines. Medications may
include vasodilators, beta blockers, diuretics, and digoxin
12. Which of the following antibodies correlates with disease activity for S.L.E
a. Anti Smith antibody
b. Anti dS DNA antibody
c. Anti Histone antibody
d. Anti Rho
Ans. (b) Anti-ds DNA antibody
13. Anti-double stranded DNA is highly specific for:
a. Systemic sclerosis
b. S.L.E.
c. Polymyositis
d. Rheumatic sclerosis
Ans. (b) S.L.E.
14. Best marker for drug-induced lupus is:
a. Antihistone antibodies
b. Anti ds DNA
c. ANA
d. Anti smith Ab
Ans. (a) Antihistone antibodies
15. Joint erosions are not a feature of:
a. Rheumatoid arthritis
b. Psoriasis
c. Multicentric reticulo-histiocytosis
d. Systemic lupus erythematosus
Ans. (d) Systemic Lupus Erythematosus
16. Deposition of Anti ds DNA Ab in kidney, skin, choroid plexus, and joints is seen
in:
a. SLE
b. Good pasture
c. Scleroderma
d. Raynaud's disease
Ans. (a) SLE
17. In SLE, the characteristic kidney lesion is:
a. Mesangial proliferation
b. Tubular fibrin deposits
c. Wire loop lesions
d. IgG deposits
Ans. (c) Wire loop lesions
18. Features of SLE include all of the following except:
a. Recurrent abortion
b. Sterility
c. Coomb's positive hemolytic anemia
d. Psychosis
Ans. (b) Sterility
19. Low doses of aspirin therapy are essentially advised for all of the following
conditions except:
a. Rheumatoid Arthritis
b. IUGR
c. Post myocardial infarction
d. Pre-eclampsia
Ans. (a) R.A. (Rheumatoid
Arthritis)
20. Primary idiopathic Polymyositis does not involve?
a. Pelvic girdle muscle
b. Neck muscle
c. Ocular muscle
d. Pharyngeal muscle
Ans. (c) Ocular Muscle
Polymyositis is a subacute inflammatory myopathy affecting
adults, and rarely children, who do not hove a no of the following:
1. Rash
2. Involvement of the extra ocular and facial muscles
3. Family history of a neuromuscular disease,
4. History of exposure to myotoxic drugs or toxins,
5. Endocrinopathy, neurogenic disease, muscular dystrophy,
biochemical muscle disorder
6. IBM as excluded by muscle biopsy analysis
21. Keratoderma -Blenorrhagicum is pathognomonic of:
a. Behcet's disease
b. Reiter's disease
c. Lyme's disease
d. Glucagonoma
Ans. (b) Reiter's syndrome
Reiter Syndrome is Associated
with:
1. Conjunctivitis
2. Uveitis
3. Urethritis
4. Arthritis
5. Keratoderma blenorrhagicum
22. Recurrent oro-genital ulceration with arthritis is seen in:
a. Behcet’s disease
b. Gonorrhoea
c. Reiter's syndrome
d. Syphilis
Ans. (a) Behcet's disease
23. Lilac coloured (heliotrope) pigmentation over the face is characteristic of:
a. Dermatomyositis
b. Polymyositis
c. Systemic lupus erythematosus
d. Systemic sclerosis
Ans. (a) Dermato-myositis
• Characteristic, possibly pathognomonic cutaneous features of
dermatomyositis: Heliotrope, Gottron papules.
• Characteristic but not pathognomonic features of
dermatomyositis:
a. Malar erythema, poikiloderma in a photosensitive distribution
b. Violaceous erythema on the extensor surfaces, and periungual
and cuticular changes
c. Flat, red rash involving the face and upper trunk or other
body surfaces, including knees, elbows, neck, anterior chest
(ie, v sign), or back and shoulders (ie, shawl sign)
24. All the following are features of Behcet's syndrome except:
a. Recurrent aphthous stomatitis
b. Multi-system involvement
c. Seen only in the tropics
d. Common in youngsters
Ans. (c) Seen only in Tropics
25. Which of the following is wrong about Sjogren syndrome?
a. Saliva has increased concentration of IgA
b. Saliva has increased concentration of sodium
c. Saliva has increased concentration of phosphate
d. Maximum amount of saliva secretion is <1.5 ml in 15 min
Ans. ( c) Saliva has increased concentration of
Phosphate
• Sjogren syndrome leads to reduced salivary flow with
unstimulated whole salivary flow < l.5ml in 15 minutes.
• The normal pH of saliva is 6.0 to 7.5. The buffer systems
responsible for human saliva buffer capacity include the
bicarbonate, phosphate and protein systems. These systems
protect the teeth against demineralization by maintaining
optimal pH for hydroxyapatite.
• In Sjogren syndrome the value of phosphate in saliva is reduced
leading to lower pH values and development of dental caries.
• Normal concentrations of total calcium, total protein and levels
of amylase activity indicate that the remaining functional acinar
cells are capable of synthesis and secretion of primary saliva
with normal composition despite the marked lymphocytic
infiltration and structural changes.
26. Drug for management of Xerostomia?
a. Cevimeline
b. 3, 4 aminopyridine
c. Neostigmine
d. Physostigmine
Ans. (a) Cevimeline
Cevimeline hydrochloride is a cholinergic agent with
muscarinic agonist activity prominently affecting the M1
and M3 receptors prevalent in exocrine glands. This
increases the salivary secretions and reduced the dry
mouth manifestations in Xerostomia. Other drug used is
pilocarpine.
27. Most common lymphoma associated with Sicca syndrome is:
a. MALToma
b. Burkitt lymphoma
c. DLBCL
d. Lymphoplasmacytic lymphoma
Ans. (a) MALToma
• Among patients with Sjogren syndrome, the incidence of non-
Hodgkin lymphoma is 4.3% (18.9 times higher than in the general
population), with a median age at diagnosis of 58 years. The
mean time to the development of non-Hodgkin lymphoma after
the onset of Sjogren syndrome is 7.5 years.
• The most common histologic subtype of non-Hodgkin lymphoma
in Sjogren syndrome is mucosa-associated lymphoid tissue (MALT)
lymphoma, which can develop in any non-lymphoid tissue
infiltrated by periepithelial lymphoid tissue-most commonly the
salivary glands, but also the stomach, nasopharynx, skin, liver,
kidneys, and lungs.
28. Sicca syndrome is associated with all except:
a. Rheumatoid arthritis
b. Midline granuloma
c. Sarcoidosis
d. Chronic active hepatitis
Ans. (b) Midline granuloma
• Primary Sjogren syndrome occurs in the absence of another
underlying rheumatic disorder, whereas secondary Sjogren
syndrome is associated with another underlying rheumatic
disease, such as systemic lupus erythematosus (SLE),
rheumatoid arthritis (RA), or scleroderma.
• Sjogren like syndromes are seen in patients infected with HIV,
HTLV-1, and hepatitis C.
29. All of the following may be associated with Sjogren syndrome, except :
a. Dry eyes
b. Dry mouth
c. Parotid gland enlargement
d. Systemic manifestations
Ans. (d) Systemic manifestations
30. Sicca syndrome is associated with all, Except :
a. Midline granuloma
b. Chronic active hepatitis
c. Rheumatoid arthritis
d. Scleroderma
Ans. (a) Midline granuloma