KMU Past Paper Practice
Oligoarticular and Axial Inflammatory Arthritis
Final Year MBBS • 20 A-Type Single Best Answer MCQs • Clinical Reasoning & Application
MCQ 1
Question:
A 38-year-old man presents with swelling of the right knee, left ankle and one metatarsophalangeal joint. He has no fever. Synovial fluid from the knee shows negatively birefringent needle-shaped crystals. Which diagnosis best explains his oligoarticular presentation?
MCQ 2
Question:
A 32-year-old woman has inflammatory swelling of three joints for 7 weeks. There is no psoriasis, preceding infection or crystal deposition. Which finding would most strongly suggest that her apparently oligoarticular disease is evolving toward rheumatoid arthritis?
MCQ 3
Question:
A 35-year-old man has inflammatory swelling of two lower-limb joints. He is afebrile and clinically stable. Initial assessment does not establish a specific diagnosis. What is the most appropriate overall management principle?
MCQ 4
Question:
A young adult has recurrent inflammatory swelling of the knees and ankles. Examination also reveals tenderness over a tendon insertion. Which feature most strongly shifts the differential diagnosis toward a spondyloarthritis rather than rheumatoid arthritis?
MCQ 5
Question:
A 29-year-old man with chronic axial inflammatory disease has increasing stooped posture and marked limitation of spinal movement. Which pathological process best explains the progressive loss of spinal mobility?
MCQ 6
Question:
A patient with ankylosing spondylitis has developed severe fixed kyphosis after years of poorly controlled disease. Which therapeutic goal is most realistic at this stage?
MCQ 7
Question:
A 31-year-old man with ankylosing spondylitis reports increasing difficulty performing daily activities because of hip pain and restricted movement. Which finding indicates clinically important peripheral joint involvement?
MCQ 8
Question:
A 27-year-old man develops inflammatory arthritis after an episode of gastroenteritis. Stool symptoms have resolved. Which mechanism best explains the subsequent joint inflammation?
MCQ 9
Question:
A man develops asymmetric lower-limb arthritis after an infectious illness. He asks whether finding an organism in an inflamed joint is expected in reactive arthritis. Which response best reflects the diagnosis?
MCQ 10
Question:
A 24-year-old man has asymmetric arthritis after a diarrheal illness. His symptoms are improving and there is no evidence of persisting infection. Which initial therapeutic approach is most appropriate for his joint symptoms?
MCQ 11
Question:
A patient has inflammatory arthritis involving several peripheral joints. Radiographs of the hands show severe destructive changes, including shortening and telescoping of digits. Which psoriatic arthritis pattern best explains this presentation?
MCQ 12
Question:
A patient with inflammatory finger arthritis undergoes radiography. One joint demonstrates a tapered phalangeal end fitting into an expanded adjacent bone. Which diagnosis should this finding support?
MCQ 13
Question:
A 41-year-old patient presents with inflammatory arthritis suggestive of psoriatic arthritis but has no obvious plaques on the arms or legs. Which additional examination is most appropriate before rejecting the diagnosis?
MCQ 14
Question:
A patient with psoriasis presents with inflammatory arthritis. Rheumatoid factor is positive at a low titre. Which interpretation is most appropriate?
MCQ 15
Question:
A 5-year-old child develops a limp and hip discomfort after a recent viral upper respiratory illness. The child is systemically well and symptoms have been present for only 2 days. Which diagnosis is an important alternative to chronic childhood inflammatory arthritis?
MCQ 16
Question:
An 8-year-old child has persistent swelling of two joints. The child also has pallor, bruising and generalized bone pain. Which diagnosis must be actively considered before labeling the presentation as juvenile idiopathic arthritis?
MCQ 17
Question:
A 6-year-old child has persistent arthritis of the knee and ankle. Blood tests show mild inflammatory marker elevation, but rheumatoid factor is negative. Which interpretation is most appropriate?
MCQ 18
Question:
A child with persistent oligoarticular juvenile idiopathic arthritis has active inflammation confined mainly to one large joint despite initial symptomatic therapy. Infection has been excluded. Which treatment may provide effective local control?
MCQ 19
Question:
A 7-year-old child with chronic oligoarticular arthritis develops a flexed posture of the affected knee and reduced muscle bulk around the joint. Which aspect of management is particularly important for preventing further functional limitation?
MCQ 20
Question:
An 8-year-old child initially has arthritis affecting three joints. Several months later, additional joints become persistently inflamed. Which clinical interpretation is most appropriate?
Oligoarticular and Axial Inflammatory Arthritis
Final Year MBBS • Connecting adult oligoarthritis, ankylosing spondylitis, reactive arthritis, psoriatic arthritis and childhood oligoarticular arthritis
1. THE TOPIC IN ONE CONNECTED FLOW
Oligoarticular arthritis means inflammation affecting only a small number of joints, but the joint count alone does not provide the diagnosis. The clinical task is to connect the pattern of joint involvement with associated features, preceding events, investigations and age of the patient. In adults, an asymmetric lower-limb pattern may point toward the spondyloarthritis group, while infection and crystal arthritis must still be considered. In children, persistent limited-joint arthritis requires exclusion of alternative causes before juvenile idiopathic arthritis is accepted.
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Assess axial symptoms, enthesitis, skin/nail disease, infection history
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Targeted investigations
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Cause-specific management
Axial inflammatory disease: When inflammation predominates in the sacroiliac joints and spine, ankylosing spondylitis becomes an important diagnostic consideration. Persistent inflammation can lead to new bone formation, progressive ankylosis and loss of spinal mobility. This explains why management combines exercise and physiotherapy with anti-inflammatory treatment, with biologic therapy considered when active axial disease persists despite appropriate initial treatment.
Reactive arthritis: A gastrointestinal or genitourinary infection may trigger an immune-mediated inflammatory arthritis after the primary infection. The inflamed joint itself is typically sterile. Therefore, the diagnostic connection is preceding infection → asymmetric lower-limb arthritis ± enthesitis or mucocutaneous features → exclusion of septic arthritis → reactive arthritis.
Psoriatic arthritis: Psoriasis connects skin, nails and joints. Nail pitting or onycholysis, dactylitis, distal interphalangeal joint disease, enthesitis or sacroiliac involvement may reveal the diagnosis. When the skin lesions are subtle, examining hidden sites such as the scalp can provide the missing diagnostic clue.
Childhood oligoarticular arthritis: Persistent arthritis involving only a few joints requires careful exclusion of infection, trauma, transient synovitis and other serious conditions. Once juvenile idiopathic arthritis is established, management aims to suppress inflammation, preserve joint function and detect complications, especially clinically silent ocular inflammation in at-risk children.
2. KEY CLINICAL CONNECTIONS
Asymmetric oligoarthritis plus enthesitis or inflammatory axial symptoms suggests spondyloarthritis. Add a preceding infection and reactive arthritis moves higher; add psoriasis or nail disease and psoriatic arthritis becomes more likely.
Synovial fluid is important when infection or crystals must be excluded. HLA-B27 may support a spondyloarthritis pattern but is not diagnostic by itself. Imaging becomes useful when sacroiliac or structural joint disease is suspected.
In ankylosing spondylitis, persistent inflammation leads to stiffness and ankylosis, so regular movement is therapeutic rather than harmful. NSAIDs control symptoms; persistent active axial disease may require specialist-directed biologic therapy.
A child with a few swollen joints is not diagnosed by joint count alone. Infection and other mimics must be excluded, and ongoing care must protect function while monitoring for important complications such as uveitis.