{"id":1362,"date":"2024-04-24T13:55:00","date_gmt":"2024-04-24T13:55:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=1362"},"modified":"2025-10-01T11:39:32","modified_gmt":"2025-10-01T19:39:32","slug":"usmle-step-1-question-of-the-day-knee-pain","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-knee-pain","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Knee pain"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-knee-pain\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-knee-pain\/#B_Reactive_arthritis\" >B.&nbsp;Reactive arthritis&nbsp;<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-knee-pain\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-knee-pain\/#A_Ankylosing_spondylitis\" >A.&nbsp;Ankylosing spondylitis&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-knee-pain\/#C_Psoriatic_arthritis\" >C.&nbsp;Psoriatic arthritis&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-knee-pain\/#D_Septic_arthritis\" >D.&nbsp;Septic arthritis&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-knee-pain\/#E_Gout\" >E. Gout<\/a><\/li><\/ul><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-1'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-knee-pain\/#Main_Explanation\" >Main Explanation<\/a><ul class='ez-toc-list-level-2' ><li class='ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-knee-pain\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><\/ul><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong><em>Discover the case of a 42-year-old man with knee pain, red eyes, and foot lesions post-UTI treatment. Could it be reactive arthritis?<br><\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 42-year-old man comes to his primary care physician\u2019s office for evaluation of right knee pain, red eyes, and lesions on soles of his feet. The patient states he had a \u201curinary tract infection\u201d that was treated with antibiotics 3 weeks ago, and his symptoms appeared shortly thereafter. He has multiple sexual partners, and he uses condoms occasionally. Vitals are within normal limits. Physical examination shows bilateral conjunctival injection with scant purulent discharge at the lid margins. The right knee is mildly swollen with associated tenderness to palpation. Examination of the soles of feet is demonstrated below. Arthrocentesis of the right knee joint shows a leukocyte count of 40,000\/mm3&nbsp;but no organisms on gram-stain or culture. Which of the following is the most likely diagnosis?<\/p>\n\n\n\n<figure class=\"wp-block-image size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"758\" height=\"506\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/feet-pic.jpg\" alt=\"\" class=\"wp-image-1365\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/feet-pic.jpg 758w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/feet-pic.jpg?resize=300,200 300w\" sizes=\"auto, (max-width: 758px) 100vw, 758px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">Retrieved from:<a href=\"https:\/\/commons.wikimedia.org\/wiki\/Category:Keratoderma_blennorrhagicum#\/media\/File:Feet-Reiters_syndrome.jpg\" target=\"_blank\" rel=\"noreferrer noopener\">&nbsp;Wikimedia Commons<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A.&nbsp;Ankylosing spondylitis&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B.&nbsp;Reactive arthritis&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C.&nbsp;Psoriatic arthritis&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D.&nbsp;Septic arthritis&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E.&nbsp;Gout&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Scroll down for the correct answer!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"B_Reactive_arthritis\"><\/span>B.&nbsp;Reactive arthritis&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the Main Explanation, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Ankylosing_spondylitis\"><\/span>A.&nbsp;Ankylosing spondylitis&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Ankylosing spondylitis is a chronic inflammatory condition that presents with low back pain and morning stiffness. Although it is also a seronegative arthropathy, it is not associated with a recent infectious process.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Psoriatic_arthritis\"><\/span>C.&nbsp;Psoriatic arthritis&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>Psoriatic arthritis is another seronegative arthropathy that occurs in conjunction with psoriatic skin lesions, which are well-defined scaly erythematous plaques on extensor surfaces. An antecedent urinary tract infection and hyperkeratotic vesicles on palms and soles are atypical.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Septic_arthritis\"><\/span>D.&nbsp;Septic arthritis&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Septic arthritis usually results from inoculation of Staph aureus and presents with fever and severe, focal joint pain. Examination typically shows an erythematous tender swollen joint with associated effusion. Arthrocentesis normally reveals synovial fluid leukocytes &gt;50,000\/mm3&nbsp;and gram positive organisms on gram stain as well as culture.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Gout\"><\/span><strong>E. Gout<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Gout typically presents with acute onset (&lt;12 hours) pain and swelling in the affected joint&#8211;usually the great toe. Synovial fluid analysis reveals negatively birefringent needle-shaped crystals. Vesicular lesions and conjunctivitis are not associated with gout.&nbsp;<\/p>\n\n\n\n<h1 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span><strong>Main Explanation<\/strong><span class=\"ez-toc-section-end\"><\/span><\/h1>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" height=\"611\" width=\"1024\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/reactive-arthritis-syndrome.png?w=1024\" alt=\"reactive arthritis symptoms\" class=\"wp-image-1364\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/reactive-arthritis-syndrome.png 2056w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/reactive-arthritis-syndrome.png?resize=300,179 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/reactive-arthritis-syndrome.png?resize=768,458 768w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/reactive-arthritis-syndrome.png?resize=1024,611 1024w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/reactive-arthritis-syndrome.png?resize=1536,916 1536w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/reactive-arthritis-syndrome.png?resize=2048,1221 2048w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">This patient presents with right&nbsp;knee pain&nbsp;and&nbsp;swelling,&nbsp;bilateral conjunctivitis&nbsp;and a history suspicious for chlamydial&nbsp;urethritis, consistent with&nbsp;reactive arthritis&nbsp;(formerly called&nbsp;Reiter syndrome). The erythematous scaly lesions on the soles are&nbsp;keratoderma blennorrhagica, the cutaneous manifestation of reactive arthritis.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Reactive arthritis occurs days to weeks following a urinary tract or gastrointestinal tract infection, and it is thought to be an autoimmune process triggered by molecular mimicry, rather than a pathogen directly infecting the joint. It is highly associated with&nbsp;HLA-B27&nbsp;haplotype.&nbsp;Causative organisms include Chlamydia, Yersinia, Salmonella, Shigella, and Campylobacter. It usually presents with a&nbsp;triad&nbsp;of&nbsp;asymmetric oligoarthritis&nbsp;(especially involving knee joint),&nbsp;conjunctivitis&nbsp;and&nbsp;urethritis. Other features include&nbsp;enthesitis&nbsp;(inflammation at the tendon or ligament insertion site),&nbsp;dactylitis&nbsp;(sausage digits) and&nbsp;sacroiliitis. Common extra-articular manifestations include oral ulcers,&nbsp;keratoderma blennorrhagica&nbsp;(as in this patient) and circinate balanitis (painless erythematous lesions with small, shallow ulcers on the glans penis).&nbsp;&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Reactive arthritis&nbsp;is an&nbsp;HLA-B27-associated arthropathy that usually presents with a triad of&nbsp;urethritis, conjunctivitis&nbsp;and&nbsp;oligoarticular sterile arthritis. It generally follows a genitourinary or enteric infection. Extra-articular manifestations include oral ulcers,&nbsp;keratoderma blennorrhagica&nbsp;and circinate balanitis.&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>References<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Hannu, T. (2011). Reactive arthritis. Best Practice &amp; Research Clinical Rheumatology, 25(3), 347-357.\u00a0<\/li>\n\n\n\n<li>Carter, J. D., &amp; Hudson, A. P. (2009). Reactive arthritis: clinical aspects and medical management. Rheumatic Disease Clinics, 35(1), 21-44.\u00a0<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;________________________<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more USMLE\u00ae Step 1 practice questions? Try Osmosis by Elsevier today! Access your&nbsp;<em><strong><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/strong><\/em>&nbsp;and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/ultimate-guide\/usmle-step-1\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/the-ultimate-guide-usmle-step-1-banner.png?w=700\" alt=\"The Ultimate Guide to the USMLE Step 1: Everything you need to know\" class=\"wp-image-760\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/the-ultimate-guide-usmle-step-1-banner.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/the-ultimate-guide-usmle-step-1-banner.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><em><em><sub>The United States Medical Licensing Examination (USMLE\u00ae) is a joint program of the Federation of State Medical Boards (FSMB\u00ae) and National Board of Medical Examiners (NBME\u00ae). Osmosis is not affiliated with NBME nor FSMB.&nbsp;<\/sub><\/em><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Discover the case of a 42-year-old man with knee pain, red eyes, and foot lesions post-UTI treatment. Could it be reactive arthritis? A 42-year-old man comes to his primary care physician\u2019s office for evaluation of right knee pain, red eyes, and lesions on soles of his feet. The patient states he had a \u201curinary tract [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":1363,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,1366,1369,44],"tags":[],"class_list":["post-1362","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-questions","category-step-1-questions","category-step-1"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 1 Question of the Day: Knee pain - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-knee-pain\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 1 Question of the Day: Knee pain - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Discover the case of a 42-year-old man with knee pain, red eyes, and foot lesions post-UTI treatment. Could it be reactive arthritis? A 42-year-old man comes to his primary care physician\u2019s office for evaluation of right knee pain, red eyes, and lesions on soles of his feet. 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