[MCQ] Rheumatoid Arthritis- Part 4

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Rheumatoid Arthritis- Part 4

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Congratulations - you have completed Rheumatoid Arthritis- Part 4. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rated as %%RATING%%

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Question 1

Rheumatoid factor can be detected in ?

A	Bacterial endocarditis
B	SjÖgren syndrome
C	Systemic lupus erythematosus
D	All of the above

Question 1 Explanation:

Rheumatoid factor testing suffers from low specificity, since it can be detected in bacterial endocarditis, malaria, tuberculosis, osteomyelitis, hepatitis C (with or without cryoglobulinemia), SjÖgren syndrome, systemic lupus erythematosus, primary biliary cirrhosis, postvaccination arthropathy, and aging.

Question 2

Citrulline is generated in an inflammatory environment by the modification of which amino acid ?

A	Arginine
B	Lysine
C	Isoleusine
D	Tryptophan

Question 2 Explanation:

RA patients often produce autoantibodies directed against proteins and peptides containing amino acid citrulline. Citrulline is generated in an inflammatory environment by the modification of the amino acid arginine by the enzyme peptidylarginine deiminase

Question 3

Which of the following about Anti-CCP antibody is false ?

A	Found in sera years before the onset of joint symptoms
B	Appear earlier than rheumatoid factor
C	Does not vary with the activity of RA
D	None of the above

Question 3 Explanation:

Anti-CCP antibody has been found in sera up to 10 years before the onset of joint symptoms in patients who later develop RA and may appear earlier than rheumatoid factor. Rheumatoid factor positivity and anti-CCP antibody positivity are each associated with more severe RA. Neither test varies with the activity of RA. Higher anti-CCP antibody titer was associated with increased disease activity and inversely correlated with remission, especially in those also positive for rheumatoid factor.

Question 4

Disease-Modifying Antirheumatic Drugs (DMARDs) in RA include all except ?

A	Methotrexate
B	Gold compounds
C	D-penicillamine
D	Azathioprine

Question 4 Explanation:

DMARDs include methotrexate, sulfasalazine, hydroxychloroquine, gold salts, or D-penicillamine. Combinations of DMARDs appear to be more effective than single agents in controlling the signs and symptoms of RA.

Question 5

Out of the following Disease-Modifying Antirheumatic Drugs in RA, most rheumatologists use which one as the first drug ?

A	Methotrexate
B	Gold compounds
C	D-penicillamine
D	Sulfasalazine

Question 5 Explanation:

Methotrexate has emerged as the DMARD of choice especially in individuals with risk factors for development of bone erosions or persistent synovitis of >3 months’ duration.

Question 6

Maximal improvement is observed after how many months of methotrexate therapy ?

A	1
B	2
C	3
D	6

Question 6 Explanation:

Maximal improvement is observed after six months of methotrexate therapy, with little additional improvement thereafter

Question 7

Concurrent administration of which of the following may diminish the frequency of some side effects of methotrexate ?

A	Pyridoxine
B	Omega 3 fatty acids
C	Folic acid or folinic acid
D	Iron

Question 7 Explanation:

Methotrexate is an antimetabolite & antifolate drug. Concurrent administration of folic acid or folinic acid diminishes frequency of its side effects.

Question 8

Which of the following is false about Leflunomide ?

A	An oral antimetabolite
B	It is a pro-drug
C	Competitive inhibitor of dihydro-orotate dehydrogenase
D	Leflunomide is safe in pregnancy

Question 8 Explanation:

Leflunomide is an oral antimetabolite pro-drug which inhibits dihydro-orotate dehydrogenase, the rate limiting enzyme for de novo synthesis of pyrimidine nucleotides. Leflunomide is teratogenic. Its active metabolite is A77 1726.

Question 9

Which of the following is false about Leflunomide ?

A	Blocks pyrimidine-synthesis pathway
B	Causes hypertension
C	Hepatic adverse effects
D	Usual daily dose is 200 mg

Question 9 Explanation:

Usual daily dose is 20 mg.

Question 10

Which of the following is a TNF-neutralizing agent ?

A	Infliximab
B	Etanercept
C	Adalimumab
D	All of the above

Question 10 Explanation:

TNF-neutralizing agents include infliximab, etanercept and adalimumab

Question 11

Which of the following is a IL-1-neutralizing agent ?

A	Infliximab
B	Etanercept
C	Adalimumab
D	Anakinra

Question 11 Explanation:

IL-beta and IL-1alpha are two related proinflammatory cytokines. Anakinra is a recombinant IL-1 receptor antagonist that binds to the cell-bound IL-1 receptor and inhibits the binding of endogenous IL-1. It has been used effectively to treat adult Still’s disease and Muckle–Wells syndrome.

Question 12

Which of the following is a hereditary febrile syndrome ?

A	Familial cold autoinflammatory syndrome (FCAS)
B	Muckle-Wells syndrome (MWS)
C	Neonatal-onset multisystem inflammatory disease (NOMID)
D	All of the above

Question 12 Explanation:

Familial cold autoinflammatory syndrome (FCAS), Muckle-Wells syndrome (MWS), and neonatalonset multisystem inflammatory disease (NOMID) are hereditary febrile syndromes caused by mutations in CIAS1, the gene encoding cryopyrin (or NALP3). Features of MWS are urticarial rash, fevers, abdominal pain, limb pain, arthritis, conjunctivitis and sensorineural hearing loss. Cryopyrin regulates IL-1 production through the formation of a macromolecular complex termed the inflammasome. Patients with all three cryopyrinopathies show a dramatic response to daily injections of anakinra, the IL-1 receptor antagonist.

Question 13

Which of the following about Anakinra is false ?

A	Can be given as monotherapy or with methotrexate
B	Less effective than Anti-TNF therapy
C	Should not be combined with Anti-TNF therapy
D	None of the above

Question 14

Rituximab acts by ?

A	TNF-neutralizing action
B	IL-1-neutralizing action
C	Interfering with T cell activation
D	Depleting B cells

Question 14 Explanation:

Rituximab is a chimeric antibody directed against the B-lymphocyte cell surface marker CD20 (CD20 is not present on all plasma cells or on very early B cells). Given to RA patients who have failed anti-TNF therapy. It can be combined with methotrexate. Its therapy can be repeated at 6- month intervals when circulating B cells return.

Question 15

Abatacept acts by ?

A	TNF-neutralizing action
B	IL-1-neutralizing action
C	Interfering with T cell activation
D	Depleting B cells

Question 15 Explanation:

Abatacept is a fusion protein consisting of CTLA4 (cytotoxic T-lymphocyte-associated antigen- 4) and the Fc portion of IgG1. It inhibits T cell activation by competitively inhibiting co-stimulation of T cells that results from interaction of T cell - expressed CD28 & CD80/86 expressed by antigenpresenting cells. It is reserved for patients who have failed Anti-TNF therapy or those who have contraindications to Anti-TNF therapy.

Question 16

Immunosuppressive and cytotoxic drug used in RA is ?

A	Leflunomide
B	Cyclosporine
C	Azathioprine
D	All of the above

Question 16 Explanation:

Immunosuppressive and cytotoxic drugs used in RA are leflunomide, cyclosporine, azathioprine and cyclophosphamide.

Question 17

Which of the following is a fully human antibody to TNF ?

A	Infliximab
B	Etanercept
C	Adalimumab
D	None of the above

Question 17 Explanation:

Etanercept is a fusion protein consisting of two p75 TNF receptors linked to Fc portion of human IgG1, infliximab is a chimeric mouse/human monoclonal antibody to TNF, and adalimumab is a fully human antibody to TNF with no rodent components..

Question 18

Which of the following drug regimens provides greatest benefit in RA ?

A	TNF-neutralizing agent alone
B	TNF-neutralizing agent + methotrexate
C	TNF-neutralizing agent + methotrexate + DMARD
D	Any of the above

Question 19

Anti-TNF therapy can lead to ?

A	Reactivation of dormant tuberculosis
B	Increased risk of lymphoma
C	Development of demyelinating CNS disease
D	All of the above

Question 19 Explanation:

TNF blocking therapies is associated with reactivation of latent Mycobacterium tuberculosis and risk of other infections, induction of autoantibodies (ANAs anti dsDNA) and autoimmune diseases (SLE), worsening of severe heart failure, demyelinating CNS disease and increased risk of lymphomas (more with infliximab).

Question 20

Which of the following is administered subcuteneously ?

A	Adalimumab
B	Etanercept
C	Anakinra
D	All of the above

Question 20 Explanation:

Infliximab and Rituximab are given IV.

Question 21

Infliximab was originally called ?

A	CA1
B	CA2
C	CA3
D	CA4

Question 21 Explanation:

Infliximab was originally called CA2.

Question 22

HACA stands for ?

A	Human anti-cytoplasmic antibodies
B	Human anti-cytoskeleton antibodies
C	Human anti-chimaeric antibodies
D	Human anti-conjugation antibodies

Question 22 Explanation:

During infliximab therapy, antibodies against it are produced. These human anti-chimaeric antibodies (HACA) result in reduction of its efficacy. Use of methotrexate with infliximab reduced this antibody production.

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See all quizzes of Rheumatoid Arthritis- Part 4 here:

1 Rheumatoid factor can be detected in ?
A. Bacterial endocarditis
B. SjÖgren syndrome
C. Systemic lupus erythematosus
D. All of the above

2 Citrulline is generated in an inflammatory environment by the
modification of which amino acid ?
A. Arginine
B. Lysine
C. Isoleusine
D. Tryptophan

3 Which of the following about Anti-CCP antibody is false ?
A. Found in sera years before the onset of joint symptoms
B. Appear earlier than rheumatoid factor
C. Does not vary with the activity of RA
D. None of the above

4 Disease-Modifying Antirheumatic Drugs (DMARDs) in RA include
all except ?
A. Methotrexate
B. Gold compounds
C. D-penicillamine
D. Azathioprine

5 Out of the following Disease-Modifying Antirheumatic Drugs in
RA, most rheumatologists use which one as the first drug ?
Harrison’s 16th Ed. 1975
A. Methotrexate
B. Gold compounds
C. D-penicillamine
D. Sulfasalazine

6 Maximal improvement is observed after how many months of
methotrexate therapy ?
A. 1
B. 2
C. 3
D. 6

7 Concurrent administration of which of the following may diminish
the frequency of some side effects of methotrexate ?
A. Pyridoxine
B. Omega 3 fatty acids
C. Folic acid or folinic acid
D. Iron

8 Which of the following is false about Leflunomide ?
A. An oral antimetabolite
B. It is a pro-drug
C. Competitive inhibitor of dihydro-orotate dehydrogenase
D. Leflunomide is safe in pregnancy

9 Which of the following is false about Leflunomide ?
A. Blocks pyrimidine-synthesis pathway
B. Causes hypertension
C. Hepatic adverse effects
D. Usual daily dose is 200 mg.
Usual daily dose is 20 mg.
10 Which of the following is a TNF-neutralizing agent ?
A. Infliximab
B. Etanercept
C. Adalimumab
D. All of the above

11 Which of the following is a IL-1-neutralizing agent ?
A. Infliximab
B. Etanercept
C. Adalimumab
D. Anakinra

12 Which of the following is a hereditary febrile syndrome ?
A. Familial cold autoinflammatory syndrome (FCAS)
B. Muckle-Wells syndrome (MWS)
C. Neonatal-onset multisystem inflammatory disease (NOMID)
D. All of the above

13 Which of the following about Anakinra is false ?
A. Can be given as monotherapy or with methotrexate
B. Less effective than Anti-TNF therapy
C. Should not be combined with Anti-TNF therapy
D. None of the above
14 Rituximab acts by ?
A. TNF-neutralizing action
B. IL-1-neutralizing action
C. Interfering with T cell activation
D. Depleting B cells

15 Abatacept acts by ?
A. TNF-neutralizing action
B. IL-1-neutralizing action
C. Interfering with T cell activation
D. Depleting B cells

16 Immunosuppressive and cytotoxic drug used in RA is ?
A. Leflunomide
B. Cyclosporine
C. Azathioprine
D. All of the above

17 Which of the following is a fully human antibody to TNF ?
A. Infliximab
B. Etanercept
C. Adalimumab
D. None of the above

18 Which of the following drug regimens provides greatest benefit
in RA ?
A. TNF-neutralizing agent alone
B. TNF-neutralizing agent + methotrexate
C. TNF-neutralizing agent + methotrexate + DMARD
D. Any of the above
19 Anti-TNF therapy can lead to ?
A. Reactivation of dormant tuberculosis
B. Increased risk of lymphoma
C. Development of demyelinating CNS disease
D. All of the above

20 Which of the following is administered subcuteneously ?
A. Adalimumab
B. Etanercept
C. Anakinra
D. All of the above

21 Infliximab was originally called ?
A. CA1
B. CA2
C. CA3
D. CA4

22 HACA stands for ?
A. Human anti-cytoplasmic antibodies
B. Human anti-cytoskeleton antibodies
C. Human anti-chimaeric antibodies
D. Human anti-conjugation antibodies

Rheumatoid Arthritis

[MCQ] Rheumatoid Arthritis- Part 4

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Rheumatoid Arthritis- Part 4

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