Welcome to your 2. 🦠 Acute Monoarthritis & Infective Arthritis Arena — 40 Integrated MCQs
1.
A man with chronic right hip pain is being assessed for tuberculous arthritis. Which additional historical feature would most increase suspicion of tuberculosis?
2.
A 62-year-old man presents with a hot, swollen knee, confusion and blood pressure of 82/48 mmHg. Joint aspiration cannot be performed immediately. Which action is most appropriate?
3.
A 7-year-old boy is initially observed for a mild postviral limp. The following day, he develops fever, increasing hip pain and an inability to bear weight. Which action is most appropriate?
4.
A febrile child refuses to bear weight. Ultrasound shows a hip effusion, but the report does not identify its cause. Which interpretation is most appropriate?
5.
A patient has completed treatment for hip tuberculosis and has no evidence of active infection. However, severe joint destruction causes disabling pain and major difficulty walking. Which management approach best addresses the remaining problem?
6.
Examination of a patient with chronic right hip monoarthritis shows painful restriction of movement. Which hip movements are particularly likely to become limited in this clinical setting?
7.
A 2-year-old child has a limp, a knee effusion and mild inflammatory-marker elevation. Joint-fluid testing identifies a bacterial pathogen associated with relatively subtle presentations in young children. Which organism best fits this pattern?
8.
A patient with suspected tuberculous arthritis has a normal chest radiograph. What is the most appropriate conclusion?
9.
A patient with suspected tuberculous arthritis has a mildly reduced hemoglobin concentration but no marked neutrophilic leukocytosis. What is the best interpretation of this result?
10.
An adult has a six-month history of hip pain and progressive stiffness. Radiographs show periarticular osteopenia, marginal erosions and gradual narrowing of the joint space. Which diagnosis best fits this combination?
11.
A patient with tuberculous arthritis has a large persistent collection around the hip despite appropriate medical treatment. What is the most appropriate next management step?
12.
A 28-year-old man with suspected tuberculous arthritis walks with an antalgic gait. What is the most likely reason for this gait pattern?
13.
A man develops an infected knee during a documented bloodstream infection. He has no penetrating injury, recent injection or nearby wound. Which route most plausibly explains entry of the organism into the joint?
14.
A 74-year-old woman develops acute knee swelling. Radiographs show chondrocalcinosis, and synovial microscopy reveals rhomboid crystals with weak positive birefringence. Which diagnosis best explains these findings?
15.
A patient with chronic hip monoarthritis undergoes joint aspiration. Why is obtaining a synovial sample clinically important?
16.
A young child has a tense hip effusion caused by bacterial infection. In addition to inflammatory tissue damage, increasing pressure within the capsule threatens the femoral head. Which mechanism best explains this risk?
17.
A woman taking immunosuppressive treatment develops an acutely painful knee. Synovial fluid contains 22,000 leukocytes/µL, predominantly neutrophils, and Gram staining shows no organisms. Which interpretation is most appropriate?
18.
A patient with chronic hip monoarthritis is being assessed for pyogenic septic arthritis. Which feature argues most strongly against typical acute pyogenic infection?
19.
A patient with persistent monoarthritis of the hip is being evaluated. Which history would make acute pyogenic septic arthritis more likely than tuberculous arthritis?
20.
A 28-year-old man presents with persistent monoarthritis of the hip. Which feature would most strongly suggest an inflammatory rheumatological disorder rather than isolated tuberculous arthritis?
21.
Tuberculous arthritis of the hip has been confirmed in a 28-year-old man. What is the most appropriate specific management principle?
22.
A patient with suspected tuberculous arthritis has inconclusive initial investigations, and tissue confirmation is required. Which investigation is most appropriate for obtaining diagnostic tissue?
23.
A 4-month-old infant has fever and cries when the left hip is moved. The infant moves the right leg freely but keeps the left leg still. Which description best explains this finding?
24.
An adult with a previous history of inflammatory arthritis develops a new hot, swollen knee and fever. An intra-articular corticosteroid injection is being considered, but the cause of the current episode has not been established. Which approach is most appropriate?
25.
A patient with tuberculous arthritis is being counselled before discharge. Which advice is most important for long-term outcome?
26.
A patient receiving appropriate treatment for confirmed knee tuberculosis develops a large periarticular abscess with persistent discharge. Which additional management approach is most appropriate?
27.
A child has fever, refuses to walk and has markedly painful hip movement. Plain radiographs show no abnormality. Which interpretation should guide the next step?
28.
A patient with long-standing tuberculous arthritis of the hip has visible wasting of the thigh muscles. What does this finding most directly indicate?
29.
A patient being treated for tuberculous arthritis suddenly develops severe worsening of hip pain, high fever and marked systemic toxicity. What is the most important immediate concern?
30.
A patient with chronic knee swelling has synovial histology showing caseating granulomas. Acid-fast staining is negative. Which interpretation is most appropriate?
31.
A radiograph of the affected hip shows periarticular osteopenia with gradual joint-space narrowing and marginal bony changes. In the context of chronic hip pain, weight loss and low-grade fever, what is the most appropriate interpretation?
32.
A 55-year-old man develops severe atraumatic knee pain over several hours. Examination reveals warmth, an effusion and restricted movement, but his temperature and serum C-reactive protein are normal. Which approach is most appropriate?
33.
An adult undergoes knee washout and receives antibiotics for bacterial arthritis. After three days, fever persists, pain worsens and C-reactive protein rises. Which interpretation best guides management?
34.
A 28-year-old man has 5 months of hip pain, stiffness, weight loss and low-grade fever. Examination reveals an antalgic gait and painful restriction of hip movement. Which diagnosis best explains the overall clinical pattern?
35.
A patient with chronic monoarthritis has elevated ESR and CRP. How should these findings be interpreted?
36.
A 28-year-old man presents with gradually progressive right hip pain for 5 months. He also reports low-grade evening fever, reduced appetite and weight loss. Which feature most strongly favors tuberculous arthritis over a mechanical hip disorder?
37.
A patient with confirmed knee tuberculosis reports substantial pain relief after several weeks of treatment and asks to stop medication. Which advice is most appropriate?
38.
A man develops sudden painful swelling of the first metatarsophalangeal joint after previous similar episodes. His serum uric acid is within the laboratory reference range during the attack. Which interpretation is most appropriate?
39.
A patient receiving treatment for tuberculous arthritis asks why physiotherapy is included in his management plan. What is the best explanation?
40.
A haemodynamically stable adult has a painful swollen knee and suspected bacterial infection. Aspiration can be performed promptly, and antibiotics have not yet been given. Which sequence best preserves diagnostic yield?
