Rheumatology: disseminated gonococcal infection: 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: disseminated gonococcal infection

Sample item

A 22-year-old sexually active woman has fever, migratory polyarthralgia, painful swelling over the extensor tendons of the right wrist and a few pustules on the hands and feet. Joint fluid culture is negative. Which treatment is most appropriate?

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

The answer and the reasoning

D. Intravenous ceftriaxone

Disseminated gonococcal infection presents with the dermatitis, tenosynovitis and migratory polyarthralgia triad, and joint cultures are often negative. A third-generation cephalosporin such as ceftriaxone is the first-line therapy because fluoroquinolone and penicillin resistance is widespread. Co-treatment for Chlamydia trachomatis is added unless it is excluded.

Option by option

  • A. Oral ciprofloxacin

    Fluoroquinolone resistance in gonococci is common, so ciprofloxacin is no longer recommended.

  • B. Intra-articular corticosteroid injection

    Intra-articular steroid is inappropriate in infectious arthritis and would impair clearing of the infection.

  • C. Oral penicillin V

    Penicillin resistance is common and oral penicillin V gives inadequate coverage.

  • D. Intravenous ceftriaxone (correct)

    Correct. Ceftriaxone covers Neisseria gonorrhoeae despite widespread resistance to older agents.

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.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Intravenous ceftriaxone. Disseminated gonococcal infection presents with the dermatitis, tenosynovitis and migratory polyarthralgia triad, and joint cultures are often negative.

Why is "Oral ciprofloxacin" not the answer?

Fluoroquinolone resistance in gonococci is common, so ciprofloxacin is no longer recommended.

Why is "Intra-articular corticosteroid injection" not the answer?

Intra-articular steroid is inappropriate in infectious arthritis and would impair clearing of the infection.

Why is "Oral penicillin V" not the answer?

Penicillin resistance is common and oral penicillin V gives inadequate coverage.

What concept does this question test?

It tests Rheumatology: disseminated gonococcal infection in General Medicine. A third-generation cephalosporin such as ceftriaxone is the first-line therapy because fluoroquinolone and penicillin resistance is widespread. Co-treatment for Chlamydia trachomatis is added unless it is excluded.

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: disseminated gonococcal infection?

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.