Welcome to your Crystal Arthropathies, Septic Arthritis & Rheumatic Fever Arena
1.
A 67-year-old man with gout has reduced renal function and marked urate underexcretion. Which pharmacological approach is generally more rational than using a uricosuric drug?
2.
A 63-year-old man with chronic gout has recurrent renal colic. Urinalysis shows acidic urine with crystal formation. Which complication of his underlying disease is most likely?
3.
A patient receiving penicillin is prescribed probenecid. The antibiotic concentration rises despite no change in the administered dose. Which process has been inhibited?
4.
A 60-year-old man with chronic kidney disease develops an acutely painful swollen ankle. He has a history of peptic ulcer disease. Which drug class is most appropriate for suppressing the acute inflammation when NSAIDs are unsuitable?
5.
A 58-year-old man with recurrent gout begins long-term therapy. Two weeks later, he experiences another painful attack despite a reduction in serum urate. Which explanation is most appropriate?
6.
A patient with tophaceous gout is prescribed allopurinol. Which biochemical change is expected?
7.
A patient with an acute gout attack receives a drug that reduces pain by inhibiting cyclo-oxygenase activity. Which effect is responsible for the clinical improvement?
8.
A patient with chronic mycobacterial arthritis develops a fluctuant periarticular swelling that is painless and not warm. Which pathological event most directly produced this finding?
9.
A throat isolate produces complete hemolysis on blood agar and appears as Gram-positive cocci in chains. Which additional laboratory result best supports identification as Streptococcus pyogenes?
10.
A 72-year-old woman has recurrent episodes of acute knee inflammation. Imaging shows chondrocalcinosis, and synovial fluid contains weakly positively birefringent crystals. Which underlying pathological process best explains her condition?
11.
A myocardial biopsy from a child with acute rheumatic carditis shows a focus of fibrinoid change surrounded by lymphocytes and activated macrophages. Which lesion is being described?
12.
A man with longstanding osteomyelitis has a fragment of devitalized bone lying within a cavity surrounded by new bone. Why does this fragment persist despite antimicrobial treatment?
13.
A 74-year-old woman presents with acute painful swelling of the knee. Radiography demonstrates linear calcification within the meniscus and articular cartilage. Joint fluid contains short rhomboid crystals. Which associated disorder should be considered?
14.
A strain of Streptococcus pyogenes resists opsonization and phagocytosis during pharyngeal infection. Which bacterial component is chiefly responsible for this property?
15.
A 45-year-old man receiving azathioprine for an autoimmune disorder is started on allopurinol. He later develops oral ulcers, anemia and leukopenia. Which mechanism best explains this adverse interaction?
16.
A 60-year-old man with diabetes develops an acutely painful swollen knee after repeated intra-articular procedures. Blood cultures and synovial fluid cultures grow the same organism. Which route most likely produced the joint infection?
17.
A 12-year-old boy develops migratory polyarthritis and carditis after an untreated throat infection. Throat culture is now negative. Which investigation would best support the required evidence of preceding infection?
18.
A patient with an infected upper molar develops pain and tenderness over the cheek with purulent nasal discharge. Which anatomical relationship best explains the spread?
19.
A 69-year-old patient presents with a hot swollen knee and fever. Synovial fluid contains monosodium urate crystals. Which interpretation is most appropriate?
20.
A 30-year-old man has chronic monoarthritis with gradual cartilage loss and a periarticular abscess. Synovial fluid microscopy is nondiagnostic. Which next specimen is most likely to establish the underlying pathology?
21.
A 52-year-old man with gout and recurrent uric acid stones is being considered for probenecid. Which feature makes this drug less suitable?
22.
A patient who cannot tolerate allopurinol is prescribed febuxostat for chronic gout. Which feature is shared by both medicines?
23.
A 35-year-old woman with a history of recurrent rheumatic fever develops progressive exertional dyspnea. Surgery reveals thickened valve leaflets, fused commissures and shortened chordae tendineae. Which long-term process produced these changes?
24.
A 6-year-old child with untreated septic arthritis later develops shortening and deformity of the affected limb. Which structure was most likely damaged during the infection?
25.
A patient receiving antituberculous therapy develops hyperuricemia and painful arthritis. Which drug most likely caused the problem by competing with urate for renal tubular secretion?
26.
A 42-year-old woman has gradually progressive knee pain, swelling and restriction of movement for six months. Examination shows wasting of the surrounding muscles with little redness or warmth. Synovial biopsy reveals epithelioid cells, multinucleated giant cells and central necrosis. Which mechanism best explains the lesion?
27.
A 49-year-old man develops abrupt severe pain and swelling of the first metatarsophalangeal joint after dehydration. Synovial fluid contains monosodium urate crystals and numerous neutrophils. Which event most directly initiates the inflammatory response?
28.
A child with rheumatic fever develops involuntary purposeless movements, emotional lability and difficulty writing several weeks after the joint symptoms improve. Which manifestation is most likely present?
29.
A 15-year-old girl with chronic osteomyelitis has intermittent discharge from a sinus over the tibia. Imaging shows a shell of reactive bone surrounding the infected area. Which term describes this reactive structure?
30.
A 13-year-old boy develops fever and severe pain over the upper tibia. MRI shows marrow inflammation in the metaphysis. Which vascular feature made this site particularly susceptible to hematogenous infection?
31.
A 61-year-old woman develops recurrent gout after treatment for hypertension. Laboratory assessment suggests reduced renal urate clearance rather than increased production. Which medicine is the most likely contributor?
32.
A 9-year-old boy has fever and a swollen knee. Synovial fluid contains abundant neutrophils, but polarizing microscopy also identifies crystals. Which interpretation is most appropriate?
33.
A patient with suspected vertebral osteomyelitis presents with severe back pain and new weakness of both legs. Which complication requires the most urgent assessment?
34.
A patient develops recurrent maxillary sinus infection after mucosal edema obstructs normal drainage. Which anatomical feature contributes to poor gravity-dependent drainage of this sinus?
35.
A patient with leukemia develops acute kidney injury and marked hyperuricemia shortly after chemotherapy. Which mechanism best explains the rise in urate?
36.
An 8-year-old boy presents with fever, severe hip pain and refusal to bear weight. The joint is held in slight flexion, and ultrasound shows an effusion. Aspiration yields turbid fluid with a very high neutrophil count. Which process is most responsible for the early destruction of articular cartilage?
37.
A child presents with fever, migratory pain in the knees and ankles, and a new cardiac murmur three weeks after a sore throat. No organisms are isolated from the joints. Which pathogenic event best explains the illness?
38.
A patient receiving colchicine for an acute gout attack develops severe diarrhea, muscle weakness and reduced blood-cell counts. Which pharmacological action explains both its therapeutic and toxic effects?
39.
A patient presents with acute monoarthritis. Serum urate measured during the attack is within the reference range. Which conclusion is most appropriate?
40.
A 56-year-old man with recurrent attacks of painful arthritis has a firm nodule excised from the helix of his ear. Histology shows pale needle-shaped spaces surrounded by macrophages, multinucleated giant cells and fibrosis. Which pathological process best explains this lesion?
