Q.1 Which autoantibody is most specific for systemic lupus erythematosus (SLE)?
Anti-dsDNA
Anti-Ro
Anti-La
Anti-Smith
Explanation - While anti-dsDNA is sensitive for SLE, anti-Smith antibody is the most specific marker for the disease.
Correct answer is: Anti-Smith
Q.2 Morning stiffness lasting more than 1 hour is characteristic of which condition?
Osteoarthritis
Fibromyalgia
Rheumatoid arthritis
Gout
Explanation - RA presents with prolonged morning stiffness (>60 minutes), unlike osteoarthritis where stiffness usually lasts less than 30 minutes.
Correct answer is: Rheumatoid arthritis
Q.3 Which joint is most commonly affected first in gout?
Knee
First metatarsophalangeal joint
Hip
Shoulder
Explanation - The first MTP joint, known as podagra, is the classic initial site of gouty arthritis.
Correct answer is: First metatarsophalangeal joint
Q.4 What is the most common extra-articular manifestation of ankylosing spondylitis?
Psoriasis
Uveitis
Oral ulcers
Erythema nodosum
Explanation - Anterior uveitis is the most common extra-articular manifestation in patients with ankylosing spondylitis.
Correct answer is: Uveitis
Q.5 Which laboratory marker correlates best with disease activity in rheumatoid arthritis?
Rheumatoid factor
Anti-CCP
ESR/CRP
ANA
Explanation - Inflammatory markers ESR and CRP are useful to monitor disease activity, unlike autoantibodies that remain static.
Correct answer is: ESR/CRP
Q.6 Which HLA subtype is strongly associated with ankylosing spondylitis?
HLA-DR4
HLA-DR3
HLA-B27
HLA-DQ2
Explanation - More than 90% of patients with ankylosing spondylitis are HLA-B27 positive.
Correct answer is: HLA-B27
Q.7 A malar rash sparing the nasolabial folds is a hallmark of which disorder?
Dermatomyositis
Systemic lupus erythematosus
Scleroderma
Psoriasis
Explanation - The classic butterfly malar rash in SLE characteristically spares the nasolabial folds.
Correct answer is: Systemic lupus erythematosus
Q.8 Which drug is commonly used as the first-line treatment for acute gout?
Colchicine
Allopurinol
Febuxostat
Probenecid
Explanation - Colchicine is a first-line treatment in acute gout, while allopurinol and febuxostat are used for chronic urate-lowering therapy.
Correct answer is: Colchicine
Q.9 What is the most common cardiac manifestation of systemic lupus erythematosus?
Myocarditis
Libman-Sacks endocarditis
Pericarditis
Arrhythmias
Explanation - Pericarditis is the most frequent cardiac complication in SLE patients.
Correct answer is: Pericarditis
Q.10 Which antibody is most specific for rheumatoid arthritis?
ANA
Anti-dsDNA
Anti-CCP
Rheumatoid factor
Explanation - Anti-cyclic citrullinated peptide (anti-CCP) antibody is highly specific for RA.
Correct answer is: Anti-CCP
Q.11 Which of the following is a common feature of systemic sclerosis?
Raynaud’s phenomenon
Malar rash
Psoriatic plaques
Uveitis
Explanation - Raynaud’s phenomenon is present in over 90% of patients with systemic sclerosis.
Correct answer is: Raynaud’s phenomenon
Q.12 Which cytokine plays a central role in the pathogenesis of rheumatoid arthritis?
IL-1
TNF-alpha
IL-10
IL-17
Explanation - TNF-alpha is a key cytokine driving inflammation in RA, making it a major therapeutic target.
Correct answer is: TNF-alpha
Q.13 A 35-year-old woman presents with dry eyes, dry mouth, and parotid enlargement. Which is the most likely diagnosis?
Sjögren’s syndrome
SLE
RA
Dermatomyositis
Explanation - Sjögren’s syndrome is characterized by xerostomia, keratoconjunctivitis sicca, and salivary gland enlargement.
Correct answer is: Sjögren’s syndrome
Q.14 In dermatomyositis, which skin sign is pathognomonic?
Butterfly rash
Gottron’s papules
Erythema nodosum
Discoid lesions
Explanation - Gottron’s papules over the MCP and PIP joints are pathognomonic for dermatomyositis.
Correct answer is: Gottron’s papules
Q.15 Which vasculitis is most strongly associated with hepatitis B infection?
Polyarteritis nodosa
Wegener’s granulomatosis
Takayasu arteritis
Churg-Strauss syndrome
Explanation - Polyarteritis nodosa is a medium-vessel vasculitis associated with HBV in many cases.
Correct answer is: Polyarteritis nodosa
Q.16 Which laboratory test is most useful for diagnosing giant cell arteritis?
ANA
Anti-CCP
ESR
HLA-B27
Explanation - An elevated ESR is almost universally seen in giant cell arteritis, aiding diagnosis.
Correct answer is: ESR
Q.17 Which drug is contraindicated in acute gout attack?
NSAIDs
Colchicine
Allopurinol
Corticosteroids
Explanation - Allopurinol should not be started during an acute gout attack as it can worsen symptoms.
Correct answer is: Allopurinol
Q.18 CREST syndrome is a limited form of which disease?
Dermatomyositis
Scleroderma
SLE
RA
Explanation - CREST is a limited variant of systemic sclerosis involving Calcinosis, Raynaud’s, Esophageal dysmotility, Sclerodactyly, and Telangiectasia.
Correct answer is: Scleroderma
Q.19 Which vasculitis classically presents with asthma and eosinophilia?
Polyarteritis nodosa
Giant cell arteritis
Churg-Strauss syndrome
Takayasu arteritis
Explanation - Eosinophilic granulomatosis with polyangiitis (Churg-Strauss) typically presents with asthma and eosinophilia.
Correct answer is: Churg-Strauss syndrome
Q.20 Which renal lesion is most characteristic of lupus nephritis?
Focal segmental glomerulosclerosis
Wire-loop lesions
Membranous nephropathy
Minimal change disease
Explanation - Lupus nephritis often shows immune complex deposition in glomeruli forming wire-loop lesions.
Correct answer is: Wire-loop lesions
Q.21 What is the first-line treatment for polymyalgia rheumatica?
NSAIDs
Methotrexate
Low-dose corticosteroids
Biologics
Explanation - PMR responds dramatically to low-dose corticosteroids, often within days.
Correct answer is: Low-dose corticosteroids
Q.22 A ‘pencil-in-cup’ deformity is seen in which arthritis?
RA
Psoriatic arthritis
Gout
Osteoarthritis
Explanation - Radiographs of psoriatic arthritis may show pencil-in-cup deformity due to bone resorption.
Correct answer is: Psoriatic arthritis
Q.23 Which vasculitis is most common in children?
Kawasaki disease
Takayasu arteritis
Henoch-Schönlein purpura
PAN
Explanation - Henoch-Schönlein purpura (IgA vasculitis) is the most common systemic vasculitis in children.
Correct answer is: Henoch-Schönlein purpura
Q.24 What is the hallmark radiologic finding in ankylosing spondylitis?
Pencil-in-cup deformity
Bamboo spine
Osteophytes
Joint space narrowing
Explanation - Fusion of vertebrae in ankylosing spondylitis leads to the bamboo spine appearance.
Correct answer is: Bamboo spine
Q.25 Which antibody is highly specific for systemic sclerosis?
Anti-centromere
Anti-Scl-70
Anti-dsDNA
Anti-CCP
Explanation - Anti-Scl-70 (anti-topoisomerase I) is specific for diffuse systemic sclerosis.
Correct answer is: Anti-Scl-70