Rosh Emergency Medicine Practice Test

In a patient suspected of reactive arthritis, which physical exam findings would align with the most likely diagnosis?

1. Conjunctival injection and keratoderma blennorrhagica

2. Erythema of the pharynx and posterior cervical lymphadenopathy

3. Macular rash on palms and posterior uveitis

4. Swollen erythematous joint and fever

The correct answer is: Conjunctival injection and keratoderma blennorrhagica

In cases of reactive arthritis, which typically arises in response to an infection elsewhere in the body, certain physical exam findings can indicate its presence. The presence of conjunctival injection and keratoderma blennorrhagica specifically pertains to the characteristic manifestations associated with this condition. Conjunctival injection refers to redness of the conjunctiva, indicating an inflammatory process, while keratoderma blennorrhagica reflects the skin lesions that can manifest in patients with reactive arthritis, particularly those types associated with sexually transmitted infections like Chlamydia. These findings highlight the typical triad of arthritis, urethritis, and conjunctivitis often seen in reactive arthritis. In contrast, the other options present findings that do not align with reactive arthritis. Erythema of the pharynx and cervical lymphadenopathy are more indicative of a viral or bacterial pharyngitis rather than a reactive process. The macular rash on palms and posterior uveitis is often associated with other conditions such as viral exanthems or autoimmune diseases, rather than reactive arthritis itself. Swollen, erythematous joints and fever can occur in various forms of arthritis but are not as specific to reactive arthritis when considered in light of the other presented findings. Thus