Welcome to your Arthritis, Rheumatoid Disorders & Rheumatology Arena
1.
A 35-year-old man with arthritis following urethritis has conjunctival redness and hyperkeratotic lesions on the soles. Which diagnosis best integrates these findings?
2.
A physician explains weekly methotrexate therapy to a patient and then asks the patient to describe how and when the medicine will be taken and which symptoms should be reported. What is the main purpose of this communication technique?
3.
A 32-year-old man has asymmetric lower-limb arthritis, heel pain and painless oral ulcers following a gastrointestinal infection. Which finding most directly accounts for his heel pain?
4.
A 63-year-old man presents with sudden severe pain, warmth and swelling of one knee associated with fever. He has a history of rheumatoid arthritis treated with immunosuppressive drugs. Which next diagnostic step is most important?
5.
A 44-year-old woman with rheumatoid arthritis is started on a short course of oral glucocorticoid while waiting for a conventional DMARD to become effective. Which cellular action produces the rapid improvement in synovitis?
6.
A patient presents with an acutely swollen knee two weeks after urethral symptoms. He is febrile and unable to bear weight. Which next step is most important before diagnosing reactive arthritis?
7.
A patient with psoriatic arthritis has severe destruction of a distal interphalangeal joint. Imaging shows tapering of one bone end with expansion of the adjacent bone. Which radiological description is most appropriate?
8.
An eight-year-old child has daily high fever, an evanescent rash and arthritis. During admission, the child develops persistent fever, pallor, thrombocytopenia and liver dysfunction. Which complication is most likely?
9.
A 27-year-old man has inflammatory low-back pain, reduced chest expansion and tenderness at both Achilles tendon insertions. Pelvic imaging shows bilateral sacroiliac erosions. Which pathological process best explains the later development of marked spinal rigidity?
10.
A 42-year-old woman has psoriasis, nail separation and painful swelling of several finger joints. Radiography shows erosions beside irregular new-bone formation. Which pathological feature best distinguishes this disease from rheumatoid arthritis?
11.
A seven-year-old boy is evaluated for persistent joint pain. He has pallor, bruising, nocturnal bone pain and hepatosplenomegaly. Which diagnosis should be excluded before classifying the illness as juvenile idiopathic arthritis?
12.
A patient with chronic psoriasis develops shortening and severe deformity of several digits due to extensive destruction of phalangeal joints. Which clinical pattern is represented?
13.
A patient taking methotrexate for rheumatoid arthritis develops increasing toxicity after an acute decline in renal function. Which pharmacokinetic property best explains this finding?
14.
A young adult has inflammatory back pain and bilateral sacroiliitis. Which additional finding would most strongly support ankylosing spondylitis rather than diffuse idiopathic skeletal hyperostosis?
15.
A patient receiving methotrexate develops a dry cough, progressive dyspnea and diffuse pulmonary infiltrates. There is no clear evidence of infection. Which adverse reaction should be suspected?
16.
A 61-year-old woman with advanced osteoarthritis has severe limitation of hip movement. The femoral head shows a smooth, polished, ivory-like area where cartilage has been lost. Which pathological change produced this appearance?
17.
A 50-year-old woman with rheumatoid arthritis is prescribed trimethoprim-containing therapy for an intercurrent infection while taking methotrexate. Soon afterward, she develops oral ulceration and pancytopenia. Which mechanism best explains this interaction?
18.
Articular cartilage obtained during knee replacement shows clusters of proliferating chondrocytes adjacent to areas of matrix depletion and surface fissuring. Which interpretation is most appropriate?
19.
A woman with inflammatory polyarthritis has negative rheumatoid factor. Which additional finding would most strongly favor psoriatic arthritis over rheumatoid arthritis?
20.
A 29-year-old woman with rheumatoid arthritis plans pregnancy. She is currently receiving methotrexate with good disease control. Which safety concern requires urgent review of her treatment?
21.
A six-year-old girl has persistent swelling of both knees and one ankle for three months. She has no fever, rash or psoriasis. Which feature is most important for placing her juvenile arthritis into an initial classification category?
22.
A 24-year-old man with established ankylosing spondylitis reports progressive exertional breathlessness. Chest examination shows markedly reduced expansion without focal lung signs. Which mechanism most likely explains this symptom?
23.
A 55-year-old man develops knee osteoarthritis several years after an untreated ligament injury. The affected joint has abnormal alignment and instability. Which mechanism most likely accelerated cartilage destruction?
24.
A 12-year-old boy has arthritis of the knees and ankles, heel tenderness and recent onset of inflammatory buttock pain. Which juvenile idiopathic arthritis category is most likely?
25.
A 29-year-old man develops painful swelling of the right knee and left ankle three weeks after dysentery. Joint aspiration shows inflammatory fluid without organisms. Which mechanism best explains his arthritis?
26.
A 39-year-old woman with symmetrical inflammatory polyarthritis has positive anti-citrullinated protein antibodies. Synovial biopsy shows marked lining-cell hyperplasia, lymphoid aggregates and increased vascularity. Which mediator most directly promotes osteoclast formation at the joint margin?
27.
A 36-year-old man has an entire swollen toe, tenderness at the plantar fascia and mild sacroiliac pain. Examination reveals scalp plaques and nail pitting. Which diagnosis is most likely?
28.
A 25-year-old man with chronic inflammatory back pain has a positive HLA-B27 test. His asymptomatic brother is also HLA-B27 positive. Which interpretation is most appropriate?
29.
A 31-year-old man with long-standing ankylosing spondylitis develops sudden severe neck pain after a minor road-traffic incident. Neurological examination is initially normal. What is the most appropriate clinical interpretation?
30.
A 48-year-old woman with rheumatoid arthritis develops pain, numbness and weakness in the lateral three and a half fingers. Examination shows thenar weakness. Which complication best explains these findings?
31.
A patient with rheumatoid arthritis has persistent active disease despite adequate conventional DMARD therapy. A TNF inhibitor is being considered. Which pre-treatment assessment is most important because of the drug’s mechanism?
32.
A 67-year-old obese woman has gradually progressive knee pain that worsens after prolonged walking. Radiography shows non-uniform joint-space narrowing, subchondral sclerosis and small cystic lesions beneath the articular surface. Which process most directly explains the cystic changes?
33.
A 47-year-old woman with mild rheumatoid arthritis is treated with hydroxychloroquine. Which monitoring measure is particularly important during prolonged therapy?
34.
A 52-year-old woman with chronic rheumatoid arthritis presents with progressive breathlessness and dry cough. She has no fever, and chest imaging suggests diffuse interstitial involvement. Which interpretation is most appropriate?
35.
A nine-year-old girl with persistent oligoarthritis appears well and denies ocular symptoms. Which additional assessment is most important despite the absence of eye complaints?
36.
A 30-year-old man is treated for a genitourinary infection but continues to have sterile inflammatory arthritis. Which explanation is most appropriate?
37.
A 36-year-old woman presents with symmetrical hand arthritis and morning stiffness. She also has photosensitivity, oral ulcers and a malar rash. Hand radiographs show no erosions. Which diagnosis is the most important alternative to rheumatoid arthritis?
38.
A 41-year-old woman with active rheumatoid arthritis is prescribed methotrexate. She asks why improvement will not be immediate. Which explanation is most appropriate?
39.
A patient with active rheumatoid arthritis has worsening erosions despite regular use of naproxen and good relief of pain. Which explanation best accounts for this progression?
40.
A patient asks why two biological DMARDs are not being combined despite severe rheumatoid arthritis. Which explanation is most appropriate?
