1. All are risk factors for the development of ILD in Sjögren’s syndrome that may indicate the need for screening, EXCEPT

A. Anti-Ro Ab
B. Severe dental caries
C. Neutropenia
D. Old age

2. Which of the following would support a diagnosis of organizing pneumonia in CTD-ILD?

A. Peripheral consolidations on HRCT
B. Basal honeycombing
C. Subpleural reticulation
D. Mosaic attenuation

3. A patient with Sjögren’s syndrome presents with a chronic cough. HRCT reveals thickened broncho-vascular bundles and nodules with ground-glass opacities predominantly in the upper lobes. Most likely diagnosis?

A. NSIP
B. UIP
C. Lymphocytic interstitial pneumonia (LIP)
D. COP

4. All are true except

A. Anti-MDA5-positive patients can develop rapidly progressive ILD even without significant muscle weakness
B. In systemic sclerosis, ILD is more frequent in diffuse cutaneous subsets than in limited cutaneous subsets
C. Pleural effusions are common in SSc-ILD
D. Combination of nintedanib and immunosuppressants is safe and effective in systemic sclerosis ILD

5. Which of the following is not a serum marker proposed for screening and monitoring CTD-ILD?

A. SP-D (Surfactant protein)
B. KL-6 (krebs von den Lungen 6)
C. CA 125
D. IL 6

6. In HRCT chest, overlapping features of NSIP (Nonspecific interstitial pneumonia) and OP (organising pneumonia) are seen in which CTD?

A. Idiopathic inflammatory myopathies
B. Sjogren’s Syndrome
C. Lupus
D. All the above

7. A patient with systemic sclerosis has minimal symptoms, but HRCT shows early fibrosis (<10% involvement). What is the next best step?

A. Start immunosuppressive therapy immediately
B. Start antifibrotic therapy immediately
C. Close monitoring with PFTs every 3-6 months
D. Perform bronchoscopy

8.Which of these drugs is not approved by the US Food and Drug Administration to treat SSc-ILD?

A. Nintedanib
B. Tocilizumab
C. Cyclophosphamide
D. None

9. A 35-year-old woman with systemic sclerosis has stable skin disease but a new onset of breathlessness. PFT shows FVC 70% and DLCO 50%. HRCT shows early NSIP changes. What is the best initial management?

A. Start cyclophosphamide
B. Start mycophenolate mofetil
C. Start nintedanib
D. Start high-dose steroids immediately

10.Which is the first-line treatment recommendation for rapidly progressive anti-MDA5-associated ILD?

A) High-dose corticosteroids and antifibrotics
B) High dose steroids + mycophenolate + antifibrotics
C) Combination of high-dose steroids + mycophenolate ± calcineurin inhibitor
D) Stem cell transplantation