Rheumatology 51-100 MRQ

A 26-year-old man is reviewed three months after an episode of Chlamydia-triggered reactive arthritis. He initially had asymmetric arthritis affecting the right knee and left ankle, which responded partially to NSAIDs. He reports ongoing morning stiffness and enthesitis at the Achilles tendon insertion. He asks about his long-term outlook and whether his symptoms are likely to become permanent.

Select five (5) correct answers.

A 32-year-old woman presents for follow-up six months after an episode of ReA triggered by Shigella infection. While her joint symptoms have improved, she continues to experience intermittent dactylitis and mild sacroiliac joint pain. She is HLA-B27 positive and concerned about the possibility of developing chronic arthritis or disability. You discuss her prognosis and factors influencing long-term outcomes.

Select five (5) correct answers.

A 28-year-old man presents with asymmetric arthritis affecting the right ankle and left knee, two weeks after an episode of dysentery during travel to Southeast Asia. He reports morning stiffness, right heel pain, and conjunctival irritation. There is no personal or family history of autoimmune disease. On examination, he has dactylitis of the second toe and tenderness at the Achilles tendon insertion. You suspect reactive arthritis and aim to determine whether he fulfils the diagnostic criteria.

Select five (5) correct answers.

A 31-year-old woman presents with three weeks of persistent right knee swelling, following an episode of painful urination and low-grade fever four weeks ago. She also reports red, painful eyes and pain under the heels. On examination, she has right knee effusion, tenderness at the plantar fascia insertion, and mild conjunctivitis. Urine NAAT is positive for Chlamydia trachomatis. You suspect reactive arthritis and assess whether she meets clinical diagnostic features.

Select five (5) correct answers.

A 29-year-old man presents with painful swelling of his right knee and left ankle, three weeks after experiencing a brief episode of urethral discharge and dysuria. He now also complains of heel pain and red, gritty eyes. On examination, he has tenderness over the Achilles tendon insertion and mild conjunctival injection. Urine NAAT confirms Chlamydia trachomatis. You suspect reactive arthritis but consider other differential diagnoses.

Select five (5) correct answers.

A 34-year-old woman presents with ongoing joint pain affecting her right ankle and left knee, which began two weeks after an episode of self-limited diarrhoea. She also reports fatigue, low back pain, and painful urination. There is no history of psoriasis or known autoimmune conditions. Examination shows mild conjunctivitis and tenderness at the SI joint. While reactive arthritis is likely, you consider other possible diagnoses.

Select five (5) correct answers.

A 42-year-old man presents with morning stiffness and joint swelling involving the right knee and two fingers of the left hand. He reports progressive joint discomfort over the past four months. There is no history of gastrointestinal issues or previous joint problems. He denies skin rashes, but his father has a history of a “chronic scaly skin condition.” Nail examination reveals pitting and onycholysis. He asks whether his joint condition could be related to an autoimmune disease and what might have contributed to its development.

Select five (5) correct answers.

A 38-year-old woman presents with worsening joint pain affecting her wrists and left ankle. She notes increased stiffness in the morning and tenderness over the Achilles tendon. She denies gastrointestinal or genitourinary symptoms. On further questioning, she reveals a personal history of mild plaque psoriasis. She is concerned that her joint symptoms may be related to her skin condition and wants to know what factors may have increased her risk.

Select five (5) correct answers.

A 44-year-old woman presents with progressive stiffness and joint swelling affecting her left wrist, right knee, and several distal interphalangeal joints. She has a known history of chronic plaque psoriasis, including nail pitting and onycholysis. She reports morning stiffness lasting over an hour. On examination, there is visible dactylitis and joint tenderness. You suspect psoriatic arthritis and decide to proceed with appropriate investigations to confirm the diagnosis and exclude mimics.

Select five (5) correct answers.

A 37-year-old man with a 6-year history of scalp psoriasis presents with recent onset of right knee swelling and persistent pain in his left heel. He reports intermittent morning stiffness and swelling of one toe. There is no history of trauma or gout. On examination, he has clear dactylitis, enthesitis over the Achilles tendon, and tenderness of the SI joints. You suspect psoriatic arthritis and proceed with investigations to confirm the diagnosis and evaluate disease extent.

Select five (5) correct answers.

A 39-year-old woman with a 10-year history of plaque psoriasis presents with joint swelling involving her left wrist, right knee, and two DIP joints of the right hand. She also reports fatigue and morning stiffness lasting over an hour. Nail examination reveals onycholysis and pitting. She is currently using topical corticosteroids for her skin but no systemic medications. Laboratory tests show elevated CRP, and imaging confirms erosive changes in the DIP joints. You confirm psoriatic arthritis and initiate a management plan.

Select five (5) correct answers.

A 42-year-old man with a history of nail psoriasis presents with increasing joint stiffness in his lower back and swelling in the right ankle and left elbow. He has tried over-the-counter NSAIDs with partial relief. MRI of the sacroiliac joints shows bilateral sacroiliitis, and CRP is elevated. He is not currently on any disease-modifying therapy. You diagnose axial and peripheral psoriatic arthritis. He is concerned about long-term disability and asks about effective management options.

Select five (5) correct answers.

A 46-year-old woman with a 12-year history of plaque psoriasis presents with worsening joint pain in her wrists, knees, and several distal interphalangeal joints. She has been previously diagnosed with psoriatic arthritis but had inconsistent follow-up. She reports increasing fatigue, joint stiffness, and difficulty gripping objects. Examination reveals joint deformities, dactylitis, and limited range of motion. You are concerned about long-term outcomes of poorly controlled PsA.

Select five (5) correct answers.

A 52-year-old man with longstanding psoriatic arthritis presents with worsening mobility, joint deformities, and increased cardiovascular concerns. He has been non-adherent with DMARD therapy and has not attended follow-ups regularly. On exam, he has fixed joint deformities in the hands and knees, and difficulty walking due to heel pain. He also mentions occasional blurry vision in one eye. You evaluate him for known complications of poorly controlled PsA.

Select five (5) correct answers.

A 41-year-old man with a 7-year history of plaque psoriasis is diagnosed with psoriatic arthritis after developing asymmetric arthritis affecting the knees and DIP joints. He reports increasing morning stiffness and fatigue. X-rays show erosive changes in multiple small joints. He has not yet started any DMARDs but is concerned about how this condition may affect his long-term health and function.

Select five (5) correct answers.

A 55-year-old woman with long-standing psoriatic arthritis presents with worsening joint pain, reduced range of motion, and increasing stiffness. She previously responded to methotrexate but stopped treatment 18 months ago. She has since developed enthesitis, axial back pain, and mild visual blurring. She asks about the expected disease course and potential long-term effects.

Select five (5) correct answers.

A 35-year-old man presents with pain and swelling in his left ankle, right knee, and several DIP joints of the hand. He has morning stiffness for about an hour and dactylitis in one toe. He does not recall any gastrointestinal or genitourinary infections. There is no visible psoriasis, but his father has a history of scaly skin patches. Laboratory tests show mildly elevated CRP and negative rheumatoid factor and anti-CCP antibodies. You suspect psoriatic arthritis but consider other differentials.

Select five (5) correct answers.

A 50-year-old woman presents with joint pain involving the hands and wrists, especially the DIP joints, along with stiffness and mild fatigue. She has a 20-year history of chronic plaque psoriasis, particularly on the scalp and nails. Examination reveals nail pitting, joint tenderness, and mild dactylitis. Her CRP is elevated, and RF and anti-CCP are negative. You consider psoriatic arthritis, but want to rule out potential mimics.

Select five (5) correct answers.

A 48-year-old man presents with joint pain affecting his right knee and several fingers of the left hand. He reports morning stiffness and a swollen “sausage digit.” His past history includes scalp psoriasis and a recent flare of nail pitting. Blood tests show elevated CRP, and serology for rheumatoid factor and anti-CCP is negative. You suspect psoriatic arthritis and evaluate him using appropriate diagnostic criteria.

Select five (5) correct answers.

A 51-year-old woman presents with stiffness in her hands and painful swelling of the DIP joints. She has a history of nail psoriasis and occasional dactylitis. Her rheumatoid factor and anti-CCP antibodies are negative. Imaging reveals joint space narrowing and periostitis. You consider the diagnostic criteria for psoriatic arthritis.

Select five (5) correct answers.

A 28-year-old man presents with persistent lower back pain and stiffness for the past six months. The stiffness is worse in the morning and improves with exercise. He reports difficulty sleeping due to nocturnal back discomfort and has a brother diagnosed with ankylosing spondylitis. He denies recent trauma or heavy lifting. Examination reveals reduced spinal flexion and tenderness over both sacroiliac joints. Imaging is pending, and you consider his risk profile.

Select five (5) correct answers.

A 33-year-old man is referred for assessment of chronic back pain that began in his early twenties. He reports morning stiffness lasting over an hour, improvement with activity, and limited lumbar flexibility. He also notes intermittent right heel pain. He has no personal history of psoriasis, bowel disease, or uveitis. Blood tests reveal elevated inflammatory markers. You begin evaluating his risk profile and consider associated factors.

Select five (5) correct answers.

A 29-year-old man presents with chronic back pain that began insidiously at age 23. The pain improves with exercise but worsens at rest and during the night. He also reports right heel pain and morning stiffness lasting more than an hour. There is no history of trauma, psoriasis, or uveitis. On examination, he has reduced lumbar flexion and tenderness over the sacroiliac joints. You suspect ankylosing spondylitis and proceed with diagnostic evaluation.

Select five (5) correct answers.

A 32-year-old male presents with chronic back stiffness, particularly in the mornings, which improves with movement and worsens with prolonged rest. He has had intermittent heel pain and now reports occasional chest tightness. On examination, Schober’s test shows reduced spinal flexion, and his chest expansion is limited. You suspect ankylosing spondylitis and plan an appropriate investigative workup.

A 30-year-old man presents with a three-year history of chronic lower back pain, prolonged morning stiffness, and fatigue. Symptoms improve with exercise and worsen with rest. He has no peripheral joint involvement, psoriasis, or bowel symptoms. Imaging reveals bilateral sacroiliitis, and HLA-B27 is positive. His CRP is persistently elevated. He has never been treated with any long-term therapy and asks about how his condition should be managed.

Select five (5) correct answers.

A 45-year-old man with established ankylosing spondylitis presents for review. He was previously managed with NSAIDs but has had worsening axial symptoms and persistent elevation of CRP. He experiences sleep disruption due to nocturnal pain and has reduced spinal mobility. He does not have peripheral arthritis or extra-articular manifestations. He is not on any biologic therapy. You assess optimal next steps in management.

Select five (5) correct answers.

A 38-year-old man with a 12-year history of ankylosing spondylitis presents with worsening stiffness, mid-back pain, and increasing difficulty with mobility. He also reports blurry vision in one eye over the past few days. He has been inconsistently adherent to therapy. On examination, he has marked limitation in spinal flexion, chest expansion of 1 cm, and tenderness at the sacroiliac joints. You assess him for potential complications of his poorly controlled disease.

Select five (5) correct answers.

A 49-year-old man with long-standing ankylosing spondylitis presents for review after experiencing a sudden loss of vision in one eye and chest discomfort on exertion. He has a rigid spine and reduced chest expansion on examination. His inflammatory markers have been persistently elevated, and he has not yet commenced biologic therapy. You assess for serious complications of AS, including those beyond the musculoskeletal system.

Select five (5) correct answers.

A 35-year-old man with early-stage ankylosing spondylitis presents to discuss his long-term outlook. He was diagnosed one year ago after experiencing chronic lower back pain, morning stiffness, and reduced spinal mobility. HLA-B27 is positive, CRP is mildly elevated, and X-rays show minimal sacroiliitis. He is currently managed with NSAIDs and physical therapy, with plans to escalate if needed. He wants to know what factors influence disease progression.

Select five (5) correct answers.

A 52-year-old man with a 20-year history of ankylosing spondylitis presents for routine follow-up. He has a completely fused spine, reduced chest expansion, and a past history of anterior uveitis. He continues on a TNF inhibitor and NSAIDs, but reports significant physical limitations. He asks about what determines prognosis in advanced AS and what future complications to expect.

Select five (5) correct answers.

A 27-year-old man presents with a three-year history of chronic lower back pain, worse in the mornings and at night, improving with exercise. He has a positive HLA-B27 test, and recent imaging shows active inflammation of the sacroiliac joints on MRI. His inflammatory markers are elevated, and he has a history of intermittent right heel pain suggestive of enthesitis. You consider whether he meets criteria for ankylosing spondylitis.

Select five (5) correct answers.

A 40-year-old woman presents with a history of inflammatory back pain and reduced spinal mobility. She has a known HLA-B27 positive status and is experiencing her first episode of anterior uveitis. MRI of her pelvis shows bilateral sacroiliitis. ESR and CRP are elevated. She is currently not on long-term treatment. You consider her clinical features in relation to established diagnostic criteria for AS.

A 34-year-old man presents with a three-year history of chronic lower back pain and stiffness. The stiffness is worse in the morning and improves with movement. He denies trauma, fevers, or weight loss. Examination reveals reduced lumbar flexion and tenderness over the sacroiliac joints. His inflammatory markers are mildly elevated. X-rays do not yet show sacroiliitis. You consider ankylosing spondylitis but must rule out mimicking conditions.

Select five (5) correct answers.

A 42-year-old woman presents with back pain and stiffness that have worsened over the last year. The symptoms are worse in the morning and improve after movement. She has no known autoimmune disease. On exam, she has reduced lumbar flexibility and limited chest expansion. Labs show elevated ESR and CRP. X-ray shows no sacroiliitis. You suspect ankylosing spondylitis but want to rule out alternative diagnoses.

Select five (5) correct answers.

A 26-year-old man presents with progressive lower back pain and early morning stiffness for the past eight months. His symptoms improve with activity and worsen after periods of rest. He also reports a recent episode of redness and pain in his right eye, diagnosed as anterior uveitis. There is no family history of autoimmune disease. Physical examination reveals reduced spinal flexion and tenderness over the sacroiliac joints. You suspect a spondyloarthropathy and assess his risk factors.

Select five (5) correct answers.

A 38-year-old woman presents with persistent left-sided sacroiliac pain and a history of Achilles tendinitis. She denies skin or bowel symptoms but mentions a brother with Crohn’s disease and a father with ankylosing spondylitis. Her CRP is elevated, and she is HLA-B27 positive. You suspect a spondyloarthropathy and review her risk profile.

Select five (5) correct answers.

A 29-year-old man presents with chronic low back pain, worse at night and improving with activity. He has morning stiffness lasting over 45 minutes and recently had a flare of unilateral anterior uveitis. On exam, he has tenderness over the sacroiliac joints and restricted spinal flexion. His symptoms began over a year ago. You suspect a spondyloarthropathy and plan an appropriate investigative workup.

A 33-year-old woman presents with chronic buttock pain, morning stiffness, and Achilles tendinopathy. She has no skin or bowel symptoms. She denies trauma or neurological symptoms. Examination reveals tenderness over both sacroiliac joints and decreased lumbar flexibility. You suspect axial spondyloarthritis and consider investigations to support your diagnosis.

Select five (5) correct answers.

A 31-year-old man with axial spondyloarthritis presents with ongoing lower back pain, prolonged morning stiffness, and fatigue. He has been trialled on NSAIDs for the past 3 months with only partial relief. MRI confirms bilateral sacroiliitis. He has no peripheral arthritis, psoriasis, or gastrointestinal symptoms. He is motivated to improve mobility and prevent long-term disability. You consider the next best steps in his management.

Select five (5) correct answers.

A 42-year-old woman with psoriatic spondyloarthritis presents with worsening back stiffness and new pain in her knees and ankles. She has significant nail pitting and a known history of plaque psoriasis. She has tried NSAIDs with some relief. Imaging reveals sacroiliitis and joint effusion in the right knee. Her inflammatory markers are elevated. You plan a comprehensive management strategy.

A 44-year-old man with long-standing axial spondyloarthritis presents with worsening back stiffness and recent episodes of blurred vision. He has a history of bilateral sacroiliitis and has been on intermittent NSAIDs, but is not taking biologic therapy. His Schober’s test is reduced, and he has limited chest expansion. He asks about potential complications of his disease.

A 37-year-old woman with a diagnosis of reactive arthritis (a type of spondyloarthropathy) following a gastrointestinal infection presents for follow-up. She reports continued joint stiffness and has developed pain in her right heel and left eye. She is concerned about long-term effects of her condition and asks what complications may arise if the disease is not optimally managed.

Select five (5) correct answers.

A 36-year-old man with axial spondyloarthritis presents for a review of his long-term prognosis. He was diagnosed three years ago and has responded moderately to NSAIDs. His CRP remains mildly elevated, and he is HLA-B27 positive. He has not yet started biologic therapy. On exam, lumbar flexion is reduced and Schober’s test is abnormal. He asks what factors might influence how his disease will progress over time.

Select five (5) correct answers.

A 48-year-old woman with psoriatic arthritis involving the axial skeleton presents for a flare review. She has ongoing enthesitis and worsening sacroiliac pain. She has had three episodes of anterior uveitis and developed hip arthritis two years after diagnosis. Despite use of NSAIDs and a short trial of methotrexate, she has not achieved stable disease. She asks what features are linked to worse long-term outcomes.

Select five (5) correct answers.

A 30-year-old male presents with a 2-year history of chronic lower back pain and prolonged morning stiffness. He states that his symptoms improve with movement but worsen with rest. He has also experienced episodic right heel pain and redness of the eye that resolved with topical steroids. His CRP is elevated, and HLA-B27 is positive. Pelvic X-ray is normal. You suspect a spondyloarthropathy and are considering classification criteria.

Select five (5) correct answers.

A 41-year-old woman presents with chronic buttock pain, stiffness that lasts over an hour in the morning, and a recent episode of anterior uveitis. She has no skin rashes or bowel complaints. Her pelvic MRI shows bilateral sacroiliitis, and her CRP is elevated. HLA-B27 testing is negative. You are assessing whether she fulfils classification criteria for axial spondyloarthritis.

Select five (5) correct answers.

A 39-year-old male presents with chronic lower back pain and prolonged morning stiffness for over a year. The pain improves with activity and worsens after periods of rest. He denies peripheral joint symptoms or bowel issues. On examination, he has limited lumbar flexion and tenderness over both sacroiliac joints. Inflammatory markers are elevated, but HLA-B27 is negative, and pelvic X-ray is inconclusive. You are considering the differential diagnosis for spondyloarthropathy.

A 44-year-old woman presents with chronic spinal pain and intermittent peripheral arthritis. She reports prolonged morning stiffness and a family history of psoriasis. Imaging shows early sacroiliitis, and her CRP is mildly elevated. HLA-B27 is negative. Before confirming a diagnosis of axial spondyloarthritis, you want to consider alternate possibilities.

Select five (5) correct answers.

A 61-year-old male presents with acute onset of a painful, swollen right knee. He denies trauma or recent travel. He is febrile and appears unwell. The joint is erythematous, warm, and has a large effusion. There is no history of recent surgery. Joint aspiration is pending. You are considering septic arthritis as a leading differential and assess for predisposing risk factors.

Select five (5) correct answers.

A 43-year-old woman presents with acute monoarthritis of the left wrist. She reports a two-day history of swelling, warmth, and restricted movement. She has not had trauma or recent surgery. There is no rash, and she denies systemic symptoms. While awaiting joint aspiration and blood cultures, you evaluate her risk factors to help determine likelihood of septic arthritis.

Select five (5) correct answers.