Welcome to your 3. 🦴 Oligoarticular & Axial Inflammatory Arthritis Arena — 40 Integrated MCQs
1.
A 27-year-old man with inflammatory back pain asks why HLA-B27 testing alone cannot confirm ankylosing spondylitis. What is the best explanation?
2.
A child with arthritis affecting only a few joints is being evaluated. Which investigation is most important when infection is suspected in a markedly swollen joint?
3.
A patient with psoriasis develops swelling of an entire finger, giving it a “sausage-like” appearance. What is this finding called?
4.
A patient with oligoarticular arthritis has fever and marked swelling of one knee. Which investigation is most important when septic arthritis is a concern?
5.
A 7-year-old girl has persistent painless swelling of the left knee and right ankle. She is systemically well, inflammatory markers are mildly raised, and there is no history suggesting infection. What is the most appropriate diagnostic approach?
6.
A patient with chronic axial inflammatory arthritis remains highly symptomatic despite appropriate exercise, physiotherapy and anti-inflammatory therapy. Active axial disease is confirmed and infection has been excluded. Which escalation strategy is most appropriate?
7.
A 26-year-old man develops persistent lower back pain that is worse after rest and improves after physical activity. Which diagnosis should be considered most strongly?
8.
A man with long-standing ankylosing spondylitis is found to have a new cardiac murmur. Which cardiovascular complication is classically associated with this condition?
9.
A child with suspected oligoarticular juvenile idiopathic arthritis has a positive antinuclear antibody test. Which interpretation is most appropriate?
10.
A patient with psoriatic arthritis has persistent inflammatory joint symptoms. Which overall management principle is most appropriate?
11.
A 34-year-old man presents with swelling of the right knee and left ankle for 3 weeks. He also reports pain at the insertion of the Achilles tendon and intermittent buttock pain. There is no fever. Which disease group best explains this combination of peripheral and axial features?
12.
A patient suspected of having reactive arthritis undergoes HLA-B27 testing, which is positive. How should this result be interpreted?
13.
A 42-year-old patient with advanced ankylosing spondylitis develops progressively reduced chest expansion. Which functional consequence is most likely?
14.
A 39-year-old patient has inflammatory arthritis involving the distal interphalangeal joints and sacroiliac symptoms but denies any known skin disease. Examination of which site may provide an important diagnostic clue?
15.
A patient develops arthritis after a genitourinary infection. Which additional finding would support the diagnosis of reactive arthritis?
16.
A 36-year-old man has lower-limb arthritis following a recent urethral illness. Which investigation is most useful for identifying a persisting genitourinary trigger when clinically indicated?
17.
A 45-year-old woman has inflammatory pain and swelling affecting several distal interphalangeal joints. Examination reveals onycholysis and subtle scalp psoriasis. Which diagnosis best accounts for the joint pattern?
18.
A patient with chronic inflammatory arthritis has psoriasis, asymmetric sacroiliitis and peripheral joint involvement. Rheumatoid factor is negative. Which diagnosis best explains the overall pattern?
19.
A child presents with persistent swelling of three joints without evidence of infection or trauma. Which broad diagnostic category should be considered?
20.
A 30-year-old man with asymmetric arthritis has painless shallow oral lesions and hyperkeratotic lesions on the soles. Which diagnosis best unifies these findings?
21.
A patient with ankylosing spondylitis has predominantly axial disease without significant peripheral arthritis. The clinician is considering conventional disease-modifying antirheumatic drugs. Which statement best reflects their role?
22.
A child with persistent oligoarticular inflammatory arthritis has inadequate symptom control despite appropriate initial treatment. Which management principle is most appropriate?
23.
A 6-year-old girl has persistent arthritis affecting three joints. Her parents report no eye symptoms. Which follow-up measure remains important despite the absence of ocular complaints?
24.
A patient with suspected psoriatic arthritis has radiographs showing erosive changes together with adjacent new bone formation. Which interpretation is most appropriate?
25.
A 32-year-old man with ankylosing spondylitis asks about an important non-drug component of long-term management. Which measure is most appropriate?
26.
A patient presents with oligoarticular arthritis. Which clinical feature should raise immediate concern for joint infection rather than uncomplicated inflammatory arthritis?
27.
A 31-year-old man has established ankylosing spondylitis. Which long-term musculoskeletal complication may develop if the disease progresses?
28.
A 47-year-old man with long-standing ankylosing spondylitis develops sudden severe spinal pain after a relatively minor fall. Which complication should be considered particularly important?
29.
A 25-year-old man with ankylosing spondylitis continues to have active axial symptoms despite appropriate initial therapy and exercise. Which treatment class may be considered under specialist care?
30.
A child with persistent oligoarticular arthritis appears otherwise well. Which associated complication requires specific attention during follow-up?
31.
Which investigation is most useful for supporting the diagnosis of sacroiliitis in a patient with suspected ankylosing spondylitis?
32.
A 30-year-old man develops asymmetric arthritis of the lower limbs two weeks after an episode of diarrhea. Which diagnosis is most likely?
33.
Which feature most strongly suggests inflammatory rather than mechanical back pain in a young adult?
34.
A 28-year-old man with established ankylosing spondylitis has persistent inflammatory spinal pain despite regular exercise and physiotherapy. He has no contraindication to anti-inflammatory drugs. What is the most appropriate next pharmacological step?
35.
A young man develops arthritis, urethral symptoms and conjunctival inflammation following an infection. Which condition best explains this presentation?
36.
A young adult with chronic inflammatory back pain develops a painful red eye with photophobia. Which complication associated with ankylosing spondylitis is most likely?
37.
A 29-year-old man presents with pain and swelling of his right knee and left ankle for 10 days. Which description best classifies his pattern of joint involvement?
38.
A 38-year-old patient has painful swelling of several finger joints with nail pitting and a history of scaly plaques on the elbows. Which diagnosis is most likely?
39.
A 25-year-old man presents with asymmetric lower-limb arthritis several weeks after dysuria. Synovial fluid culture from the affected knee is sterile. Which interpretation is most appropriate?
40.
A 33-year-old man presents with arthritis of three lower-limb joints. He has preceding gastrointestinal symptoms, while another patient with similar joint involvement has psoriasis and nail changes. Which feature most strongly differentiates the second patient’s diagnosis?
