Reactive Arthritis — MCQs

10 questions

A patient presents with severe pain and swelling in his knee joint for 10 days. He also complains of pain and discomfort during urination. He says that he had diarrhea one month ago and he has been unwell since then. What is the most likely diagnosis?

In cervical cancer brachytherapy, the primary reference point for dose prescription is -

A doctor conducts criminal abortion for a woman with consent. He will be prosecuted under which of the following IPC sections?

All are characteristic features of superior semicircular canal dehiscence except?

All of the following are true of febrile seizures except-

Uncommon finding in congestive cardiac failure in a newborn -

Which of the following is not typically associated with Reiter's syndrome?

Q fever is caused by -

HLA B27 is associated with all except: a) Ankylosing spondylitis b) Pernicious anemia c) Behcet's syndrome d) Reiter's syndrome

Q10

All are used in OCD except:

Reactive Arthritis Indian Medical PG Practice Questions and MCQs

Question 1: A patient presents with severe pain and swelling in his knee joint for 10 days. He also complains of pain and discomfort during urination. He says that he had diarrhea one month ago and he has been unwell since then. What is the most likely diagnosis?

A. Psoriasis arthritis
B. Rheumatoid arthritis
C. Enteropathic arthritis
D. Reactive arthritis (Correct Answer)

Explanation: Reactive arthritis - This diagnosis is strongly supported by the triad of symptoms: **arthritis** (knee pain/swelling), **urethritis** (pain during urination), and a preceding **gastrointestinal infection** (diarrhea one month prior) [1]. - Reactive arthritis is an inflammatory arthritis triggered by an infection in another part of the body, often **gastrointestinal** or **genitourinary** [2]. *Psoriasis arthritis* - This condition is associated with **psoriasis**, a skin disease characterized by red, scaly patches, which is not mentioned in the patient's history. - While it can affect joints, it does not typically present with a preceding gastrointestinal infection or urethral symptoms. *Rheumatoid arthritis* - **Rheumatoid arthritis** typically presents with symmetric polyarticular joint involvement, often affecting smaller joints like those in the hands and feet, rather than a single large joint like the knee [3]. - It does not typically follow a gastrointestinal infection or involve urethral symptoms. *Enteropathic arthritis* - This type of arthritis is associated with **inflammatory bowel diseases** (IBD) like Crohn's disease or ulcerative colitis. - While diarrhea can be a symptom of IBD, the patient's presentation with acute urethritis points away from enteropathic arthritis as the primary diagnosis, which often involves axial skeleton or peripheral joints but typically not urethral inflammation.

Question 2: In cervical cancer brachytherapy, the primary reference point for dose prescription is -

A. Point A (Correct Answer)
B. Point B
C. Side walls of pelvis
D. Point H

Explanation: ***Point A*** - **Point A** is defined as 2 cm lateral to the central canal of the uterus and 2 cm superior to the external os, representing a dose estimation to the **parametrium** and a critical reference for tumoricidal dose. - This point serves as the **primary prescription and reporting point** for brachytherapy in cervical cancer, as it is highly correlated with treatment outcomes and complications. - Established by **ICRU Report 38** as the standard reference point for dose prescription. *Point B* - **Point B** is located 5 cm from the midline (3 cm lateral to Point A) at the level of Point A, and is primarily used to estimate the dose received by the **pelvic side wall** and regional lymphatics. - It provides an indication of dose to structures further from the applicator but is **not the primary prescription point** for the target volume in brachytherapy. *Side walls of pelvis* - The dose to the **side walls of the pelvis** is relevant for assessing potential toxicity to structures like the obturator nerve and external iliac vessels, and for ensuring adequate coverage of pelvic lymph nodes. - While critical for treatment planning, the side walls themselves are not a primary dose prescription point but rather a **region of interest** for dose constraints and coverage. *Point H* - **Point H** represents the reference point for estimating the dose to the **rectum** in brachytherapy, located at the posterior vaginal wall. - While important for assessing **rectal toxicity** and as a dose-limiting structure, Point H is used for reporting organ-at-risk doses, not for primary tumor dose prescription.

Question 3: A doctor conducts criminal abortion for a woman with consent. He will be prosecuted under which of the following IPC sections?

A. 316 IPC
B. 313 IPC
C. 312 IPC (Correct Answer)
D. 317 IPC

Explanation: ***312 IPC*** - This section of the **Indian Penal Code (IPC)** specifically deals with **causing miscarriage** or criminal abortion. - Doing so with the woman's consent, but outside of legal provisions, falls under this section. *316 IPC* - This section deals with **causing the death of a quick unborn child**, an act amounting to culpable homicide. - It would apply if the act intended to cause the death of the child, not just to induce an abortion. *313 IPC* - This section addresses **causing miscarriage without the woman's consent**. - Since the question states the abortion was done "with consent," this section is not applicable. *317 IPC* - This section pertains to the **exposure and abandonment of a child** under twelve years of age by parent or person having care of it. - This is unrelated to the act of performing an abortion.

Question 4: All are characteristic features of superior semicircular canal dehiscence except?

A. Tullio's phenomenon
B. SNHL (Correct Answer)
C. Third window phenomenon
D. Abnormal vestibular evoked myogenic potentials

Explanation: ***SNHL*** - **Superior semicircular canal dehiscence (SSCD)** typically presents with conductive hearing loss or mixed hearing loss, not sensorineural hearing loss (**SNHL**), due to the "third window" effect. - The dehiscence allows sound energy to escape, primarily affecting sound transmission to the cochlea and ossicular chain mechanics, mimicking a **conductive hearing loss**. *Tullio's phenomenon* - This is a classic symptom of **SSCD**, characterized by **vertigo** and **nystagmus** induced by loud noises. - The dehiscence causes abnormal pressure changes in the inner ear in response to sound, stimulating the vestibular system. *Third window phenomenon* - The dehiscence itself creates an abnormal "third window" in the inner ear, altering the normal fluid dynamics. - This phenomenon is central to the pathophysiology of **SSCD**, causing symptoms like **autophony** and **pulsatile tinnitus**. *Abnormal vestibular evoked myogenic potentials* - **Vestibular evoked myogenic potentials (VEMPs)**, particularly **cervical VEMPs (cVEMPs)** and **ocular VEMPs (oVEMPs)**, are characteristic findings in **SSCD**. - They show **abnormally low thresholds** and **increased amplitudes** in response to sound or vibration due to the altered inner ear mechanics from the dehiscence.

Question 5: All of the following are true of febrile seizures except-

A. Prognosis is good
B. Does not last more than 15 minutes
C. Most commonly seen between 9 months and 5 years
D. Almost invariably develop into epilepsy (Correct Answer)

Explanation: ***Almost invariably develop into epilepsy*** - This statement is **false**; only a small percentage (2-7%) of children with febrile seizures later develop **epilepsy**. - Febrile seizures are generally considered **benign** and do not typically lead to a diagnosis of epilepsy. *Prognosis is good* - The **prognosis for simple febrile seizures is excellent**, with no long-term neurological sequelae or cognitive impairment. - The risk of recurrence is present but usually decreases with age, and **most children outgrow them**. *Does not last more than 15 minutes* - **Simple febrile seizures** are defined as generalized tonic-clonic seizures lasting **less than 15 minutes**. - Seizures lasting longer than 15 minutes are considered **complex febrile seizures**, which have a slightly higher risk of recurrence but do not necessarily change the overall good prognosis. *Most commonly seen between 9 months and 5 years* - Febrile seizures typically occur in children between **6 months and 5 years of age**, with a peak incidence around **18 months**. - This age range reflects the developing brain's susceptibility to febrile illness and its ability to generate a generalized seizure response.

Question 6: Uncommon finding in congestive cardiac failure in a newborn -

A. Pedal edema (Correct Answer)
B. Tachycardia
C. Tachypnoea
D. Hepatomegaly

Explanation: ***Pedal edema*** - While **edema** can occur in newborns with **congestive heart failure (CHF)**, it is less common to see isolated **pedal edema** compared to older children or adults. - In newborns, fluid retention often manifests as **generalized edema** or **periorbital edema** due to less developed lymphatic drainage and different fluid distribution. *Tachycardia* - **Tachycardia** (increased heart rate) is a **very common** and significant finding in newborns with **CHF** as the heart attempts to maintain cardiac output. - It is an early compensatory mechanism in response to decreased pump function. *Tachypnoea* - **Tachypnoea** (increased respiratory rate) is a **common symptom** of **CHF** in newborns due to pulmonary congestion and increased effort of breathing. - The lungs become stiff and less compliant, leading to faster, shallow breathing. *Hepatomegaly* - **Hepatomegaly** (enlarged liver) is a **frequent and diagnostically important sign** of **right-sided heart failure** in newborns due to venous congestion. - The liver acts as a reservoir, and its enlargement often indicates increased systemic venous pressure.

Question 7: Which of the following is not typically associated with Reiter's syndrome?

A. Circinate balanitis
B. Oral ulcers
C. Keratoderma blenorrhagicum
D. Subcutaneous nodules (Correct Answer)

Explanation: ***Subcutaneous nodules*** - **Subcutaneous nodules** are characteristic of conditions like **rheumatoid arthritis** [1] and **rheumatic fever**, not Reiter's syndrome (reactive arthritis). - While Reiter's syndrome can present with a variety of extra-articular manifestations, these specific nodules are not part of its typical clinical picture. *Oral ulcers* - **Oral ulcers** (painless aphthous ulcers) are a known mucocutaneous manifestation that can occur in patients with Reiter's syndrome [2]. - They are one of the 'can't see, can't pee, can't climb a tree' symptoms often associated with the condition, though less common than arthritis. *Keratoderma blenorrhagicum* - **Keratoderma blenorrhagicum** is a specific skin lesion characterized by hyperkeratotic, waxy, yellow-brown papules and plaques, predominantly on the palms and soles [2]. - It is highly characteristic, though not universally present, in patients with Reiter's syndrome and is clinically and histologically indistinguishable from pustular psoriasis. *Circinate balanitis* - **Circinate balanitis** is a painless inflammation of the glans penis characterized by shallow, serpiginous erosions [2]. - It is a common mucocutaneous manifestation of Reiter's syndrome, particularly in uncircumcised males [2].

Question 8: Q fever is caused by -

A. Coxiella burnetii (Correct Answer)
B. Rickettsia typhi
C. Francisella
D. Pseudomonas

Explanation: ***Coxiella burnetii*** - **Query fever (Q fever)** is a zoonotic disease caused by the bacterium **Coxiella burnetii**. - This organism is an obligate intracellular parasite that primarily infects animals like cattle, sheep, and goats, with humans typically getting infected through inhalation of contaminated aerosols. *Francisella* - **Francisella tularensis** is the bacterium responsible for **tularemia**, also known as **rabbit fever**. - Tularemia is characterized by symptoms such as fever, skin ulcers, and swollen lymph nodes, and it has a different transmission pathway (e.g., tick bites, contact with infected animals) than Q fever. *Rickettsia typhi* - **Rickettsia typhi** is the causative agent of **murine typhus** (also known as endemic typhus). - This disease is transmitted to humans by fleas, typically from infected rodents, and its symptoms include fever, headache, and a rash, distinct from the clinical presentation of Q fever. *Pseudomonas* - **Pseudomonas aeruginosa** is a common opportunistic bacterium associated with a wide range of infections, particularly in immunocompromised individuals or those with medical devices. - It causes infections like pneumonia, urinary tract infections, and surgical site infections, but it is not associated with Query fever.

Question 9: HLA B27 is associated with all except: a) Ankylosing spondylitis b) Pernicious anemia c) Behcet's syndrome d) Reiter's syndrome

A. Ankylosing spondylitis
B. Reiter's syndrome
C. Behcet's syndrome (Correct Answer)
D. Psoriatic arthritis

Explanation: ***Behcet's syndrome*** - While Behcet's syndrome is an inflammatory condition, it is **not typically associated with HLA-B27**. It is more commonly linked to **HLA-B51**. - Its clinical presentation involves recurrent oral and genital ulcers, uveitis, and skin lesions, which are distinct from the spondyloarthritis spectrum. *Ankylosing spondylitis* - This is a classic **HLA-B27 associated spondyloarthropathy**, characterized by chronic inflammation of the sacroiliac joints and spine [1]. - The presence of HLA-B27 significantly increases susceptibility to this condition. *Reiter's syndrome* - Now more commonly referred to as **Reactive Arthritis**, this condition is strongly associated with **HLA-B27** [1]. - It often presents with a triad of arthritis, urethritis, and conjunctivitis following a genitourinary or gastrointestinal infection. *Psoriatic arthritis* - While not as strongly linked as ankylosing spondylitis or reactive arthritis, about **30-50% of patients with psoriatic arthritis test positive for HLA-B27**, especially those with spinal involvement [1]. - It is an inflammatory arthritis associated with **psoriasis** and can affect peripheral joints, the spine, and entheses.

Question 10: All are used in OCD except:

A. Behavioural therapy
B. Clomipramine
C. SSRIs
D. ECT (Correct Answer)

Explanation: ***ECT*** - **Electroconvulsive therapy (ECT)** is a treatment primarily used for severe depression that has not responded to other treatments, **schizophrenia**, and **bipolar disorder with psychotic features**, not for OCD. - While it can be considered for very severe, refractory OCD in rare cases under specific guidelines, it is not a routine or primary treatment. *Behavioural therapy* - **Exposure and response prevention (ERP)**, a type of behavioral therapy, is considered the **gold standard non-pharmacological treatment** for OCD. - ERP involves gradually exposing the individual to feared situations or thoughts and preventing them from performing ritualistic compulsions. *Clomipramine* - **Clomipramine** is a **tricyclic antidepressant (TCA)** that is well-established as an effective pharmacotherapy for OCD. - It has potent serotonin reuptake inhibition properties, making it particularly useful in treating OCD symptoms. *SSRIs* - **Selective serotonin reuptake inhibitors (SSRIs)** are considered **first-line pharmacological treatments** for OCD. - They work by increasing the levels of serotonin in the brain, helping to reduce obsessive thoughts and compulsive behaviors.

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