Rheumatology: psoriatic 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.

Try it

General Medicine · Rheumatology: psoriatic arthritis

Sample item

A 40-year-old man with scalp psoriasis has swelling of the distal interphalangeal joints, nail pitting and a sausage-shaped toe. Which radiographic finding would be characteristic?

AChondrocalcinosis of the menisciBPunched-out erosions with overhanging edgesCPencil-in-cup deformityDSymmetrical periarticular osteopenia with uniform joint space loss

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

The answer and the reasoning

C. Pencil-in-cup deformity

Psoriatic arthritis commonly involves the distal interphalangeal joints, with dactylitis, nail changes and enthesitis. Radiographs show erosions with adjacent new bone formation, periostitis, and the pencil-in-cup deformity in severe disease. Treatment starts with NSAIDs and methotrexate or leflunomide, and TNF inhibitors are used for resistant disease.

Option by option

A. Chondrocalcinosis of the menisci
Chondrocalcinosis is seen in calcium pyrophosphate disease.
B. Punched-out erosions with overhanging edges
Punched-out erosions with overhanging edges describe tophaceous gout.
C. Pencil-in-cup deformity (correct)
Correct. Erosion with bone proliferation, giving pencil-in-cup deformity, is typical.
D. Symmetrical periarticular osteopenia with uniform joint space loss
Symmetrical periarticular osteopenia with uniform narrowing is typical of rheumatoid arthritis.

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.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is C, Pencil-in-cup deformity. Psoriatic arthritis commonly involves the distal interphalangeal joints, with dactylitis, nail changes and enthesitis.

Why is "Chondrocalcinosis of the menisci" not the answer?

Chondrocalcinosis is seen in calcium pyrophosphate disease.

Why is "Punched-out erosions with overhanging edges" not the answer?

Punched-out erosions with overhanging edges describe tophaceous gout.

Why is "Symmetrical periarticular osteopenia with uniform joint space loss" not the answer?

Symmetrical periarticular osteopenia with uniform narrowing is typical of rheumatoid arthritis.

What concept does this question test?

It tests Rheumatology: psoriatic arthritis in General Medicine. Radiographs show erosions with adjacent new bone formation, periostitis, and the pencil-in-cup deformity in severe disease. Treatment starts with NSAIDs and methotrexate or leflunomide, and TNF inhibitors are used for resistant disease.

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: psoriatic 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.