Rheumatology: reactive arthritis: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Rheumatology: reactive arthritis

Sample item

A 24-year-old man has asymmetric swelling of the knee and ankle, heel pain and conjunctivitis three weeks after urethral discharge. Synovial fluid shows inflammatory cells, and cultures are negative. Which diagnosis fits best?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Reactive arthritis

Reactive arthritis is a sterile, asymmetric lower limb oligoarthritis that follows genitourinary infection (such as Chlamydia) or enteric infection (Salmonella, Shigella, Campylobacter, Yersinia). Enthesitis, conjunctivitis and urethritis are typical, and many patients are HLA-B27 positive. Treatment is with NSAIDs, with antibiotics for active chlamydial infection.

Option by option

  • A. Gonococcal arthritis

    Gonococcal arthritis presents with tenosynovitis and pustules, and the fluid may be culture positive.

  • B. Rheumatoid arthritis

    Rheumatoid arthritis causes symmetrical small joint polyarthritis.

  • C. Acute rheumatic fever

    Acute rheumatic fever follows pharyngitis and gives migratory large-joint arthritis with carditis.

  • D. Reactive arthritis (correct)

    Correct. The triad of arthritis, conjunctivitis and urethritis after genital infection with sterile fluid is characteristic.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More General Medicine questions

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Reactive arthritis. Reactive arthritis is a sterile, asymmetric lower limb oligoarthritis that follows genitourinary infection (such as Chlamydia) or enteric infection (Salmonella, Shigella, Campylobacter, Yersinia).

Why is "Gonococcal arthritis" not the answer?

Gonococcal arthritis presents with tenosynovitis and pustules, and the fluid may be culture positive.

Why is "Rheumatoid arthritis" not the answer?

Rheumatoid arthritis causes symmetrical small joint polyarthritis.

Why is "Acute rheumatic fever" not the answer?

Acute rheumatic fever follows pharyngitis and gives migratory large-joint arthritis with carditis.

What concept does this question test?

It tests Rheumatology: reactive arthritis in General Medicine. Enthesitis, conjunctivitis and urethritis are typical, and many patients are HLA-B27 positive. Treatment is with NSAIDs, with antibiotics for active chlamydial infection.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Rheumatology: reactive arthritis?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.