Q1. Which statement is false about NSAIDs?

A. Short-term IV/IM ketorolac is comparatively renal-safe versus other NSAIDs and a preferable choice for quick pain relief in elderly patients
B. Naproxen and moderate-dose celecoxib have relatively lower cardiovascular signals compared with diclofenac.
C. Diclofenac use is associated with a relatively higher risk of renal disease than naproxen.
D. NSAID exposure confers its most significant fetal risk when used in the third trimester of pregnancy.

Q2. Sotatercept mechanism in pulmonary arterial hypertension (PAH):

A. Endothelin A receptor antagonist.
B. RhoA/Rho-kinase pathway inhibitor.
C. Serine elastase inhibitor.
D. A ligand trap for activin/TGF-β family ligands

Q3. Which statement is false about ANCA-associated vasculitis?

A. ANCA positivity is observed in only ~30–50% of eosinophilic granulomatosis with polyangiitis (EGPA), with MPO/p-ANCA predominating in the ANCA-positive subgroup.
B. Anti-LAMP-2 antibodies are the more characteristic marker for EGPA with glomerulonephritis than MPA
C. Cardiac and pulmonary involvement are more frequent in EGPA than in granulomatosis with polyangiitis (GPA) or microscopic polyangiitis (MPA).
D. Skin and gastrointestinal manifestations are relatively common in EGPA compared with GPA/MPA.

Q4. Which statement is false about Crystal arthropathy?

A. BCP crystals are tiny mineral-like particles analogous to bone matrix mineral and are encountered at sites of dystrophic calcification.
B. Crowned-dens syndrome, which may mimic meningitis is classically associated with calcium-pyrophosphate deposition (CPPD) of the atlanto-odontoid region and is therefore more typical of CPPD than BCP disease.
C. Orlistat can increase intestinal oxalate absorption and has been implicated in calcium-oxalate crystal deposition syndromes.
D. BCP crystal size routinely exceeds the resolution limits of conventional compensated polarised light microscopy and is therefore easily visualised on PLM.

Q5. Clinical case- ANA Immunofluorescence Patterns

A 49-year-old woman with months of dry eyes/mouth, pruritus, and mild jaundice. Liver tests: cholestatic (ALP 4×ULN), GGT ↑, and bilirubin mildly ↑. HEp-2 IIF shows mixed patterns: dense fine speckled (DFS) 4+, multiple nuclear dots 3+, and cytoplasmic granular/mitochondria-like 4+. AMA-M2 ELISA is negative. The most appropriate next step is:

A. Reassure that an isolated high-titer DFS pattern excludes systemic autoimmune rheumatic disease; pursue non-autoimmune cholestasis workup only.
B. Mixed HEp-2 patterns with multiple nuclear dots and mitochondrial-type cytoplasmic staining can indicate AMA-negative primary biliary cholangitis (PBC); order PBC-specific ANA testing (anti-gp210, anti-SP100/line-immunoassay) and escalate PBC workup and management.
C. The cytoplasmic granular pattern is diagnostic of antisynthetase syndrome (anti-Jo-1); send a myositis panel and start empiric immunosuppression.
D. The combined ANA features indicate drug-induced lupus; stop potential offending drugs and test anti-histone antibodies instead of pursuing PBC testing.

Q6. Clinical case- systemic mastocytosis treatment strategy

54-year-old man: recurrent presyncope, flushing, abdominal pain/diarrhoea, splenomegaly, skin hyperpigmented macules. Serum tryptase 142 ng/mL. Bone marrow: dense multifocal mast-cell infiltrates with CD25/CD2 expression. KIT D816V detected, VAF 12%. Mild cytopenia and hepatic nodularity present. Which therapy is most appropriate now for advanced systemic mastocytosis (AdvSM) with KIT D816V?

A. Avapritinib (selective type-I KIT D816V inhibitor) as first-line targeted cytoreductive therapy.
B. Midostaurin (multikinase KIT inhibitor) as the only accepted first-line option.
C. Omalizumab for symptom control and prevention of anaphylaxis as the primary disease-modifying therapy.
D. Cladribine (2-CdA) induction followed by interferon-α maintenance as the standard first-line approach.

Q7. Minor salivary-gland biopsy in suspected primary Sjögren’s — which feature will not add to the diagnostic yield (beyond focus score)?

A. A plasma-cell shift (markedly increased IgA:IgG ratio in infiltrates).
B. Presence of ectopic germinal-centre-like structures with BCL6 positivity.
C. Classical lymphoepithelial lesions of the ductal epithelium.
D. Novel IHC detection biomarkers such as TRIM21 (Ro52) or ENO1 on sections.

Q8. Which statement is false about Spondyloarthritis?

A. Axial SpA biology includes IL-23-independent pathways that drive IL-17 production in entheseal and spinal tissues.
B. Bimekizumab (dual IL-17A/IL-17F neutraliser) achieves very high skin responses and matches IL-17A blockade for many dermatologic outcomes.
C. IL-23 p19 inhibitors have a substantially higher risk of mucocutaneous fungal infections than IL-17 inhibitors.
D. IL-17 blockers should be avoided in active inflammatory bowel disease; IL-23 inhibitors (and ustekinumab) are safer choices when IBD comorbidity exists.

Q9. Which statement is false about TLR7 in human immunology?

A. TLR7 is encoded on the X chromosome and mechanistically contributes to the female bias seen in systemic lupus erythematosus.
B. Loss-of-function (LOF) TLR7 variants are mainly associated with severe viral susceptibility in women.
C. Gain-of-function (GOF) TLR7 variants can cause early-onset lupus or interferonopathy phenotypes.
D. TLR7 recognises single-stranded RNA (and some self-RNA species), driving type-I interferon responses.

Q10.  Which statement is false about Posterior tibial tendon dysfunction (PTTD)?

A. The single-leg heel-raise test (inability to perform a single-leg heel rise) is one of the most sensitive functional tests for PTTD.
B. The “too-many-toes” sign (forefoot abduction visible from behind) is a classic clinical indicator of PTTD.
C. Tarsal tunnel syndrome is a relevant differential; a positive Tinel sign at the medial ankle supports tarsal tunnel.
D. PTTD classically produces an exaggerated medial longitudinal arch and hindfoot varus on standing.