This is a real-world medical entrance exam question, please give the true answer based on the question and selection. Topic name: Immunology and Rheumatology, Subject name: Medicine
Extra articular manifestation of rheumatoid arthritis is: 
Select and explain. 
A. Av fistula, B. Cutaneous hypomelanosis, C. Splenic atrophy, D. Subcutaneous nodules
D: Subcutaneous nodules
Answer: D: Subcutaneous nodules 
Explanation: Ans: d (Subcutaneous nodules)Ref: Harrison, 18 ed. pg. 2087* As many as 40% of people may show extra articular manifestations* Usually occur in individuals with high R F positivity of high ACCP.* Rheumatoid nodules seen in upto 20-30% individuals with RA.* Usually periarticular or extensor aspect but can be seen anywhere.Extra articular manifestations in RARespiratoryGastrointestinalPleral effusion with low sugarXerostomiaPneumothoraxParotid enlargementRheumatoid nodule(Kaplan syndrome)DysphagiaInterstitial fibrosisMesentric artery' occlusionPneumoniaRenalPulmonary hypertensionPyelonephritisAnalgesic nephropathyCardiacPericarditis/endocarditisCard iomyopathyMyoca rd ial infarctionAmyloidosisOcularEpisc leritis/scleri tisKerato conjunctivitis siccaConduction defects/cardiac arrhythmiasMitrsl/ aortic incompetenceScleromalacia perforans EarDefective hearing-Ossicular chain involvementNervous systemAtlantoaxial subluxation(Quad ri paresis) Peripheral neuropathyAutonoimic neuropathyMononeuritis multiplexEntrapment neuropathyPyoderma gangrenosumSkinDermal atrophyLeg ulcers/nodules BonesPeriarticular osteoporosis