Rheumatology MCQs Practice questions with explanation

Q1: An 18-year-old female presented in ER with colicky abdominal pain, diarrhea, vomiting, and
frothy urine. She gives a history of knee and ankle joint pains for which she was taking NSAIDs,
she also complained of a purpuric rash on buttocks and legs. On examination, her blood
pressure was 140/89mmhg, pulse 78/minute, respiratory rate 17/minute. Blood tests reveal
elevated creatinine 1.8mg/dL and raised IgA levels. The platelet count was also raised. Biopsy
shows increased IgA levels in the mesangium. What is the most likely diagnosis?
1. Wegner's disease
2. Henoch-Schoenlein purpura
3. Polyarteritis nodosa
4. Churg-Strauss
5. Takayasu arteritis
1. Wegner’s granulomatosis is c-ANCA associated vasculitis that commonly affects the
upper respiratory tract, lungs, and kidneys. The microscopic picture shows focal
necrotizing granulomatosis, chest radiographs show nodules and fixed infiltrates.
Treatment includes methotrexate or azathioprine.
2. Henoch-Schoenlein purpura is also known as IgA vasculitis causes inflammation of small
blood vessels in the skin, joints, intestine, and kidneys. The most prominent feature of
this vasculitis is the purpuric rash on the legs and buttocks. It mostly occurs after an
upper respiratory tract infection. It can cause kidney damage and intussusception. The
diagnosis can be made clear when arthritis, rash, and abdominal pain are present. It can
be treated with naproxen and corticosteroids as there is no specific treatment.
3. Polyarteritis nodosa is the necrotizing inflammation of medium-sized vessels in kidneys
and other organs except lungs. It is associated with hepatitis b or C virus. It is associated
with p-ANCA. Tissue biopsy shows inflammation in arteries.
4. Chrug-Strauss causes inflammation of small and medium-sized arteries in people with a
history of allergic hypersensitivity. The first stage involves airway inflammation, the
second stage involves increased eosinophils, and the third stage involves inflammation
of vessels. Treatment typically involves suppression of the immune system with
glucocorticoids, cyclophosphamide, or azathioprine.
5. Takayasu arteritis is also known as an aortic arch syndrome that causes inflammation of
large vessels with intimal fibrosis and vessel narrowing. Diagnosis is made on CT scan
and treatment includes prednisone.
Difficulty: medium
Source: Davidson's Principles and Practice of Medicine - 23rd Edition, page1119

Q2: A 40-year-old female presented to ER with shortness of breath, dry cough, and fatigue. She
complaints of painful, swollen joints and red eyes sometimes. She has a history of
nephrolithiasis. On examination, she has tender axillary lymph nodes and tender patches on her
skin. Chest radiograph shows infiltrate. Biopsy reveals non-caseating granulomas. Which of the
following is the most likely diagnosis?
1. Systemic lupus erythematosus
2. Churg-Strauss
3. Polyarteritis nodosa
4. Tuberculosis
5. Sarcoidosis
1. Systemic lupus erythematosus is an autoimmune disorder related to antibody-antigen
complexes deposition and antibody-mediated attack. It presents with typical butterfly-
rash on the face and painful swollen joints. Treatment involves immunosuppression and
corticosteroids.
2. Chrug-Strauss also known as eosinophilic granulomatosis with polyangiitis is a small
vessel vasculitis, that presents with a history of asthma sinusitis, and often acute kidney
injury. It is associated with increased eosinophils. treatment include corticosteroids.
3. Polyarteritis nodosa also called systemic necrotizing vasculitis associated with hepatitis
B and p-ANCA. Proteinuria and raised ESR is common in this condition. Treatment
involves immunosuppression and corticosteroids.
4. Tuberculosis is a contagious, air-borne lung infection caused by mycobacterium
tuberculosis. Presents with cough, night sweats, and weight loss. Diagnosed on skin
tests, blood tests, chest radiographs, and Acid-fast bacilli tests. Treatment for active
tuberculosis includes ethambutol, isoniazid, pyrazinamide, and rifampin.
5. Sarcoidosis is a multi-system disease characterized by infiltration of non-caseating
granulomas. It usually involves lungs, skin, and lymph nodes. It is characterized by
increased macrophages and CD4 and helper T-cell activation. Diagnosis is made on
history, chest radiographs, tissue biopsy of lymph nodes, and acid-fast bacilli to rule out
tuberculosis. Treatment includes NSAIDs, corticosteroids, and anti-metabolites.
Difficulty: medium
Source: Siltzbach LE, James DG, Neville E, Turiaf J, Battesti JP, Sharma OP, Hosoda Y, Mikami R,
Odaka MCourse and prognosis of sarcoidosis around the world. Am J Med571974847852

Q3: A primigravida female presented to ER with pre-term labor at 32 weeks of gestation. She
has a history of systemic lupus erythematosus and was taking medication. Which of the
following is true about the treatment of SLE in pregnancy?
1. Steroids should be discontinued because they are teratogenic
2. Cyclophosphamide should be discontinued because it is teratogenic
3. Methotrexate can be given during the first trimester but not during second and third
trimesters
4. Patients with SLE treated with high dose steroids should breastfeed their baby
5. Steroids has higher teratogenicity than methotrexate
1. Steroids can be taken during pregnancy they are converted into less active chemicals
when they cross the placenta. Prednisone is preferred over dexamethasone because it is
more efficiently broken down by the placenta.
2. Cyclophosphamide is teratogenic and should be avoided in the first 10 weeks of
gestation when the fetus is susceptible to teratogenicity. It results in high rates of fetal
losses.
3. Methotrexate is contraindicated in pregnancy as it causes craniofacial abnormalities,
limb defects, and hydrocephaly.
4. Prednisone and cyclosporin are safer in breastfeeding but methotrexate and
cyclophosphamide are contraindicated. larger molecules are less likely to be transferred
to breastmilk.
5. Methotrexate is more teratogenic than steroids. Methotrexate causes limb defects,
craniofacial defects but no such case is reported after steroid usage.
Difficulty: easy
Source:Davidson's Principles and Practice of Medicine - 23rd Edition, page 1109

Q4: a 45-year-old female presents in OPD with severe thickening and swelling of fingers and
hardening of the skin of the face and trunk. She also complains of fingers turning pale and
numb in winter and a grating sound is produced when she moves her hands. She also
complained of difficulty swallowing and bloating after meals. Laboratory testing shows ANA-
positive and high-resolution CT shows interstitial lung disease. Which of the following findings
will be seen in this patient?
1. Anti-centromere
2. Anti-topoisomerase
3. Esophageal dysmotility
4. Calciumdeposits on the skin
5. Telangiectasia
1. Anti-centromere antibodies are frequently seen in systemic lupus erythematosus,
limited scleroderma, Raynaud’s disease, Sjogren’s syndrome, rheumatoid arthritis, and
immune hemolytic anemia.
2. Anti-topoisomerase antibody is specific for the diffuse type of scleroderma but it is also
seen in systemic lupus erythematosus but lower in number as compared to
scleroderma.
3. Esophageal dysmotility can be seen in many disorders like Chagas disease, scleroderma,
pseudo-achalasia, myasthenia gravis, and multiple sclerosis.
4. It occurs in other diseases like hyperparathyroidism, chronic kidney failure, and also in
scleroderma.
5. Telangiectasia are broken blood vessels on the skin surface or mucous membranes. It is
seen in limited scleroderma.
Difficulty: medium

Q5: A 45-year-old male presents to ER with weight loss, sudden loss of appetite, abdominal
pain, excessive fatigue, and joint pains. He also complaints about lumps on the skin as well. His
blood pressure was 170/100mmhg, pulse was 87/minute, temperature 38 C, and respiratory
rate 20/minute. Laboratory tests revealed creatinine 2.2mg/dL, raised ESR, c-ANCA, and p-
ANCA are negative. Arteriography shows microaneurysms of the renal arteries. Which of the
following is the treatment in this patient?
1. Cyclophosphamide+ methotrexate
2. Steroids + cyclophosphamide
3. Aspirin
4. IVIg
5. Rituximab
1. Methotrexate is rarely used in polyarteritis nodosa, it is successfully used in Takayasu
arteritis, Wegner’s granulomatosis. Cyclophosphamide is used in polyarteritis nodosa
but combination with steroids.
2. Steroids like prednisone are used in polyarteritis nodosa and cyclophosphamide which
has shown effective results in treatment.
3. Aspirin is not indicated in polyarteritis nodosa, it will only lower the inflammatory
markers and not properly treat the disease.
4. Intravenous immunoglobulin therapy is only indicated when the patient is resistant to
corticosteroid therapy.
5. Rituximab is used in some patients who have entered the remission phase of treatment.
Difficulty: easy

Q6: A 32-year-old young male presented to ER with red teary eyes, rash on his legs, he
complains of abdominal pain, nausea, and diarrhea. He has a history of DVT twice, superficial
phlebitis, and recurrent mouth ulceration. On examination of the eye, uveitis was seen. Which
of the following is a gold standard treatment for the condition?
1. Methotrexate
2. Colchicine and NSAIDs
3. Systemic steroids and azathioprine
4. Cyclophosphamide
5. Colchicine alone
1. Methotrexate is a chemotherapeutic agent and immune-suppressant drug which is least
toxic and is used for uveitis to prevent blindness. It will not help treat the disease
properly. Other drugs like cyclophosphamide, azathioprine, rituximab can be added to
the regime.
2. Colchicine is an anti-gout agent that stops the process of swelling and is used for
mucocutaneous lesions and aspirin will reduce the inflammatory markers. In severe
attacks of mucocutaneous lesions, corticosteroids are used.
3. Immunosuppressants like azathioprine should always be used to achieve complete
remission and prevent complications. Corticosteroids alone, corticosteroid +
azathioprine, cyclophosphamide + corticosteroid, these regimes should be followed for
disease associated with complications.
4. Cyclophosphamide is an alkylating agent that has immunosuppressant effects. It can be
used alone orally or intravenously, or with a combination of other drugs like steroids.
5. Colchicine is an anti-gout drug that will treat uveitis and for other symptoms, we will
add steroids.
Difficulty: easy

Q7: A 70-year-old female presents to OPD with bluish discoloration of fingers, hematuria,
heartburn, fatigue, and joint pains off and on. Which of the following tests will help establish
the diagnosis?
1. Chest X-ray
2. MRI
3. Doppler of the fingers
4. CT scan of the chest
5. Lung biopsy
1. Chest x-ray will reveal pleural effusion, which can be due to many other causes like
congestive heart failure, pulmonary embolism, and pneumonia. Pleural effusions are
uncommon in scleroderma.
2. MRI is not the investigation of choice; we prefer a CT scan to diagnose scleroderma.
3. Doppler of fingers will not help diagnose it will only show the extent of vasculopathy.
4. Ct scan is the investigation of choice because it shows interstitial pneumonia and lower
zone pulmonary fibrosis and also shows esophageal dilatation which is seen in
scleroderma.
5. Tissue biopsy of skin lesions and lymph nodes is done not of lungs.
Difficulty: easy

Q8: A 40-year-old female comes to OPD with dry eyes and dyspareunia for the last 6 months.
She also complains of cough and fatigue with joint pains. On examination, her parotid gland
was enlarged and laboratory tests revealed anti-Ro antibodies are positive. Which of the
following tests is recommended to this patient?
1. Head CT
2. Abdominal MRI
3. Schirmer test
4. Biopsy of the labia
5. Colposcopy
1. Head CT has no significance instead CT parotid should be done to see the extent of the
abnormality.
2. Sjogren disease causes gastroparesis and irritable bowel disease for that abdominal MRI
is not recommended.
3. Schirmer test is used to check whether your eyes produce enough tears to keep them
moist or not. It is primarily used to diagnose Sjogren’s disease.
4. Biopsy of the salivary gland is done instead of biopsy of labia.
5. Colonoscopy will not help establish the diagnosis.
Difficulty: easy
Source:Davidson's Principles and Practice of Medicine - 23rd Edition, page1114

Q9: A 70-year-old female presented to ER with swelling of knee joint and severe pain.
Arthrocentesis revealed rhomboid-shaped crystals that stained deeply blue with H&E stain, and
show weak positive birefringence on light microscopy. X-ray reveals chondrocalcinosis. Which
of the following statements is true?
1. The patient has monosodium urate depositions
2. The patient has calcium oxalate depositions
3. The patient has calcium apatite deposition
4. The patient suffers from rheumatoid arthritis
5. The patient has calcium pyrophosphate depositions
1. Monosodium urate crystals are negatively birefringent and needle-shaped.
2. Calciumoxalate depositions are typically square and are positive birefringent.
3. Calciumapatite crystals are deposited in soft tissues and tendons.
4. In rheumatoid arthritis calciumpyrophosphate crystals are deposited but history is not
suggestive of rheumatoid arthritis.
5. Calciumpyrophosphate crystals are rhomboid-shaped and weak positive birefringence is
seen and they stain deep blue with H&E stain.
Difficulty: easy

Q10: A 60-year-old female presents in OPD with knee joint stiffness in the morning and
increases with activity and decreases on rest. She also complains about a crackling noise on
joint movement. X-ray shows narrowing of the joint space and osteophytes. Which of the
following treatments is recommended in this patient?
1. Methotrexate
2. Steroids
3. Acetaminophen
4. Elastic socks
5. Surgery
1. Methotrexate is chemotherapy and immunosuppressant drug. It is typically used in the
treatment of rheumatoid arthritis, psoriasis, and Crohn’s disease.
2. Steroids like prednisolone are not indicated in osteoarthritis. Such inflammation can be
treated with NSAIDs.
3. Acetaminophen is recommended first-line add-on drug in osteoarthritis if pain relief is
not enough.
4. Elastic socks will not relieve pain and stiffness.
5. Surgery is not recommended only lifestyle modification is advised.
Difficulty: easy
Source:Davidson's Principles and Practice of Medicine - 23rd Edition, page1081

Q11: A 50-year-old female presents to ER with dyspnea on exertion and orthopnea, red painful
eyes. She complains of chronic dull pain in the gluteal region for the last 5 years and stiffness in
the lower back that wakes her up in the morning. X-ray spine reveals squaring of vertebrae with
bone spur formation. On MRI sacroiliitis is seen. Which of the following is the most likely
diagnosis?
1. Mitral stenosis
2. Mitral regurgitation
3. Aortic stenosis
4. Aortic regurgitation
5. Pulmonary stenosis
1. Mitral valve stenosis is seen typically in the rheumatic fever it is not associated with
ankylosing spondylitis.
2. Mitral regurgitation is related to atrial fibrillation and pulmonary hypertension disease.
3. Aortic stenosis is related to endocarditis and not ankylosing spondylitis.
4. Aortic regurgitation along with inflammation of the aorta is seen in ankylosing
spondylitis. A disease that causes inflammation of joints of the spine. Associated with
HLA-B27, tumor necrosis factor-alpha and IL-1 are also raised in ankylosing spondylitis.
Treatment includes NSAIDs, DMARDs such as sulfasalazine, TNF-alpha blockers, and
surgery.
5. It is seen in infective endocarditis, an infection in which bacteria enter the lining of the
heart.
Difficulty: medium

Q12: A 26-year-old female presented to ER with dry cough and shortness of breath and often
complains of chest pain. Chest x-ray shows bilateral hilar lymphadenopathy. Which of the
following will indicate that the patient suffers from sarcoidosis?
1. Hemoptysis
2. Eosinophilia
3. Episcleritis
4. Erythema nodosum
5. Cranial nerve XII dysfunction
1. Hemoptysis is not seen in sarcoidosis, it is seen in asthma, chronic obstructive
pulmonary disease, acute respiratory tract infection, and bronchiectasis.
2. Eosinophilia is seen in allergic reactions, inflammatory and neoplastic disorders.
3. Episcleritis is seen in conjunctivitis, phlyctenular conjunctivitis. Uveitis is seen in
sarcoidosis.
4. Erythema nodosum is characteristic of sarcoidosis, these are tender red nodules on
shins. It is self-limiting but corticosteroids can be given in severe cases.
5. Cranial nerve 12 dysfunctions are seen in tumors, strokes, injuries, and infections.
Difficulty: easy

Q13: A 45-year-old male presents to ER with arthritis, fever, red teary eyes. He complains of
cough as well. There are tender nodules on his shins. On examination of the eyes, uveitis is
seen. Chest x-ray shows bilateral hilar lymphadenopathy. Which of the following will also be
seen in this patient?
1. Elevated PTH
2. Hypocalcemia
3. Elevated ACE
4. Decreased vitamin D
5. Hypophosphatemia
1. Elevated PTH is seen in hyperparathyroidism, prolactin is increased in sarcoidosis.
2. Hypocalcemia is seen in osteoporosis, osteopenia no such deficiency is seen in
sarcoidosis.
3. Angiotensin-converting enzyme is raised in sarcoidosis. Sarcoidosis involves skin lungs
and lymph nodes. It is associated with erythema nodusum and tender nodules are seen
on both shins. Xray reveals bilateral hilar lymphadenopathy. Treatment includes NSAIDs,
corticosteroids, and glucocorticoids.
4. Vitamin D is decreased in rickets disease, which causes bones to become soft and then
bend.
5. Hypophosphatemia is not seen in sarcoidosis, it causes muscle weakness, respiratory or
heart failure, seizures, or coma.
Difficulty: medium

Q14: A 43-year-old patient presented to ER with nasal bleed, stuffy nose, also complaints of
joint pains. He has a history of saddle-nose deformity. Xray chest reveals nodular infiltrates.
Which of the following is the induction therapy for patients with Wegner's granulomatosis?
1. Methotrexate + steroids
2. Azathioprine + steroids
3. Cyclophosphamide+ steroids
4. Trimethoprim + steroids
5. Rituximab + steroids
1. Methotrexate is chemotherapy and immunosuppressant drug. It inhibits dihydrofolate
reductase and increases adenosine levels which inhibit neutrophil adhesion to
endothelial cells. Methotrexate and steroids are given to induce remission in patients
with no life-threatening condition, but this combination rarely improves the condition.
2. Azathioprine is another immunosuppressive drug that is given with steroids for
remission maintenance. It is safely given in patients with renal insufficiency.
Azathioprine is a purine analog but not as effective as cyclophosphamide and steroids
are.
3. Cyclophosphamide is an alkylating agent that decreases DNA synthesis, cross-linking of
DNA, and apoptosis. It decreases both T and B lymphocytes. It is safer to use with
steroids but has several toxicities infection, infertility, and myelodysplasia.
4. Trimethoprim and steroids’ most important role in Wegner’s granulomatosis as a
prophylactic agent against P. Carinii and safe in all non-sulfa-allergy patients of
Wegner’s granulomatosis.
5. It is an antibody against CD20 antigen on B lymphocytes in a patient with relapsing PR3-
ANCA positive Wegner’s granulomatosis resistant to other therapies.
Difficulty: medium

Q15: A 35-year-old female presents to ER with fatigue, sleep disturbance, weakness, and
muscle spasms. Her blood pressure was 130/80mmhg, pulse 74/minute, respiratory rate
17/minute. In fibromyalgia, all of the following tests are indicated except?
1. CRP level
2. Hemoglobin level
3. WBC count
4. TSH level
5. Coagulation function test
1. CRP is raised in fibromyalgia; it shows a strong positive association with fibromyalgia
syndrome.
2. Nutritional deficiencies are associated with fibromyalgia. Iron deficiency is higher in
women with fibromyalgia.
3. Fibromyalgia patients have higher counts of white blood cells and inflammatory
markers.
4. Hypothyroidism and fibromyalgia occur frequently together. Obese people with
hypothyroidism often have fibromyalgia and positive anti-thyroperoxidase antibodies.
5. Coagulation function test is not associated with fibromyalgia.
Difficulty: medium
Source:Davidson's Principles and Practice of Medicine - 23rd Edition, page 1092

Q16: A 40-year-old female presented in OPD with painful tender joints. She was diagnosed with
rheumatoid arthritis and was taking methotrexate, sulfasalazine, and hydroxychloroquine
without adequate response. On examination 10 joints are swollen and tender. Which of the
following is the best next step?
1. Azathioprine
2. Cyclophosphamide
3. Mycophenolate
4. High dose steroids
5. Adalimumab
1. Azathioprine is a purine analog, which is converted into 6-MP. Azathioprine has only
short-term beneficial effects in rheumatoid arthritis patients. It’s less efficacious than
other DMARDs and is more toxic.
2. Cyclophosphamide is an orally active alkylating agent, which can be used to treat
rheumatoid arthritis but due to its cardiotoxicity, it should be avoided.
3. Mycophenolate is a pro-drug for mycophenolic acid which inhibits the de novo pathway
of purine synthesis. Due to its adverse gastrointestinal effects, it is avoided.
4. The primary role of steroids is induction of remission in patients with early rheumatoid
arthritis who are starting DMARD treatment, high dose can be given and then reduce
and gradually stopping it as DMARD starts its effects.
5. Adalimumab is the first-line biological drug in rheumatoid arthritis. Most of these drugs
are prescribed methotrexate to make it more efficacious. One of its adverse effects is
the reactivation of latent tuberculosis which should be kept in mind.
Difficulty: medium
Source: Davidson's Principles and Practice of Medicine - 23rd Edition, page 1096-1103

Q17: A 38-year-old female presented to OPD with complaints of muscle pain and swelling of
joints. She complains of joint pains as well. Her past medical history is positive for hypertension
treated with hydralazine and propranolol. Which of the following is characteristic of this
presentation?
1. Low complement levels
2. Anti-CCP
3. Anti-Ro
4. Anti-histone
5. RF
1. Complement levels usually increase in number when you are having an infection but it
drastically falls in diseases like lupus, rheumatoid arthritis, and cirrhosis.
2. Anti-CCP antibody test is specific for rheumatoid arthritis.
3. Anti-Ro antibodies are seen in Sjogren disease and systemic lupus erythematosus.
4. Anti-histone antibodies are only seen in systemic lupus erythematosus and drug-
induced lupus.
5. Rheumatoid factor is specific for rheumatoid arthritis only.
Difficulty: medium
Source: Antonov D, Kazandjieva J, Etugov D, Gospodinov D, Tsankov N (2004) Drug-induced
lupus erythematosus. Clin Dermatol 22:157–166. doi:10.1016/j.clindermatol.2003.12.023

Q18: A 28-year-old female presented to ER with migraine and lace-like purplish rash on the
skin. She has a history of recurrent miscarriages. Laboratory tests that reveal lupus
anticoagulants are in high titers. Which of the following will confirm that the patient is suffering
from antiphospholipid syndrome?
1. Evidence of stroke
2. Evidence of DVT
3. Elevated lupus anticoagulant is enough to establish the diagnosis
4. Elevated antiphospholipid antibody after 12 weeks
5. Fetal loss before the 10th week of pregnancy
1. Diagnosis is made on one clinical and one laboratory evidence. If there is evidence of
stroke with one laboratory test specific for APS syndrome, we will establish our
diagnosis.
2. Only evidence of DVT cannot surely confirm the diagnosis, there has to be one
laboratory test confirmation.
3. Elevated lupus anticoagulant is not enough to establish diagnosis we need to have one
clinical evidence as well.
4. Elevated antiphospholipid antibody after 12 weeks on two or more occasions is
confirmatory and it should not be less than 12 weeks.
5. Fetal loss before the 10th week of pregnancy doesn’t indicate antiphospholipid
syndrome.
Difficulty: medium
Source: Asherson RA, Cervera R, Piette JC, Shoenfeld Y. The antiphospholipid syndrome: history,
definition, classification, and differential diagnosis. In: RA Asherson, R Cervera, JC Piette, Y
Shoenfeld, editors. The antiphospholipid syndrome. Boca Raton (FL): CRC Press; 1996. pp. 3–
12.

Q19: Which of the following is true regarding reactive arthritis?
1. More frequent in the upper extremities
2. It is a clinical diagnosis
3. All patients are HLA-B27 positive
4. It involves the joints symmetrically
5. First-line therapy is with sulfasalazine
1. No, it is not limited to the upper extremities, it can also cause sacroiliitis, spondylitis.
2. Yes, it is a clinical diagnosis based on a triad of uveitis, conjunctivitis, and arthritis mostly
occurring after shigella dysentery. Reactive arthritis is also called Reiter’s disease mostly
affects males. The first line of treatment includes NSAIDs and steroids, DMARDs are
added in patients with persistent symptoms.
3. Not all patients are HLA-B27 positive only 20% show positivity.
4. No, it does not involve joints symmetrically. There could be arthritis of any joint.
5. The First line of therapy involves rest and NSAIDs and then steroids and then DMARDs if
symptoms are persistent.
Difficulty: easy

Q20: A 40-year-old female presented to ER with hemoptysis and nasal crusting. She also
complains about decreased hearing from the last 2 months. Chest X-ray shows there are pleural
nodules and infiltrates with cavitation. Urine examination reveals dysmorphic RBC. Which of
the following is the best test for this disease?
1. C-ANCA
2. P-ANCA
3. Rheumatoid factor
4. Tuberculin test
5. Blood cultures
1. Wegner’s granulomatosis is C-ANCA associated disease so this test is best for diagnosis.
Wegner’s granulomatosis most commonly presents with nasal bleed, sinusitis, nasal
crusting, deafness, and proptosis. Patients with Wegner’s are usually proteinase-3
antibody positive. Management is with high-dose steroids and cyclophosphamide.
2. P-ANCA is specific for Churg Strauss disease. It is small vessel vasculitis associated with
eosinophilia, patient presents with allergic rhinitis, nasal polyposis. It is a triad of
eosinophilia, asymmetric mono neuritis multiplex, and skin lesions.
3. Rheumatoid factor is only raised in rheumatoid arthritis. Rheumatoid arthritis is an
autoimmune inflammatory arthritis that occurs most commonly in females. Treated
with methotrexate and DMARDs.
4. Tuberculin test is a skin test for the diagnosis of tuberculosis.
5. Blood cultures are not done for rheumatoid arthritis, they are done in infections such as
typhoid rheumatoid fever.
Difficulty: easy

Rheumatology MCQs Practice questions with explanation

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