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Quiz Session - Attempts With Random Questions

AANPCB FNP Exam Questions

Page 3 of 50

41.

When conducting rounds for elderly residents in long-term care, you note that a patient has an unexplained weight loss of 20 pounds since the previous month. You note signs of dehydration and observe that oral care has not been provided. Which of the following is the most important intervention?

  • Report the situation to the appropriate state agency

  • Plan to see the resident weekly to ensure the resident's condition does not worsen

  • Meet with the nursing staff to review the plan of care

  • Discuss the situation with the director of nursing

Correct answer: Report the situation to the appropriate state agency

Unexplained weight loss, dehydration, and lack of personal care provided are signs of elder neglect. This is the most commonly encountered type of elder maltreatment, defined as the refusal or failure of a caregiver to fulfill their obligations or duties to an older person, including the provision of food, clothing, medicine, shelter, supervision, and care and services that a prudent person would deem essential for the well-being of another. Nurses and nurse practitioners are mandatory reporters of abuse and neglect, so this must be reported to the appropriate state agency immediately. Failure to report is a misdemeanor with possible penalties, including a significant fine, incarceration, or both, should the maltreatment result in death or great bodily harm to the elder.

Elder maltreatment is significantly underreported; for every one case reported, an estimated five other cases go unreported. Neglect is the most commonly encountered type of elder maltreatment. In times of economic difficulty, the rate of financial exploitation usually increases. While you may also plan to see the resident weekly and meet with the director of nursing and other nursing staff members, reporting the situation is of primary importance.

42.

You are reviewing diagnostic test results related to a potential diagnosis of hypothyroidism. You understand that when thyroid-stimulating hormone (TSH) levels increase to more than 10 mIU/L, a significant increase in which of the following is also noted?

  • Low-density lipoprotein (LDL)

  • Blood glucose levels

  • Creatine kinase

  • Alanine aminotransferase

Correct answer: Low-density lipoprotein (LDL)

When the patient's TSH level increases to more than 10 mIU/L, even in the presence of a normal free T4 level, a significant increase in LDL often occurs; this increases cardiovascular disease risk, and levothyroxine treatment should be initiated.

Hypothyroidism rarely causes significant changes in blood glucose levels. Elevated levels of creatine kinase are related to decreased levels of T3 rather than increased TSH. Hyperthyroidism rather than hypothyroidism is associated with elevated levels of alanine aminotransferase.

43.

Which of the following patients is most likely to be at an increased risk of developing vitamin B12 anemia?

  • A patient who is being treated for peptic ulcer disease caused by H. pylori

  • A patient who had a gastric balloon placed due to morbid obesity

  • A patient who takes glyburide for type 2 diabetes

  • A patient who takes a daily ascorbic acid supplement

Correct answer: A patient who is being treated for peptic ulcer disease caused by H. pylori

Vitamin B12 deficiency, also referred to as pernicious anemia, most commonly occurs as a result of atrophic gastritis (loss of the gastric parietal cells). The gastric parietal cells produce intrinsic factor which is necessary for binding to vitamin B12 ingested in the diet. Individuals may experience loss of the gastric parietal cells as the result of autoimmune destruction (autoimmune gastritis), or secondarily to underlying disease states such as type 1 diabetes, Graves disease, Addison disease, hypothyroidism, and hypoparathyroidism. Dietary practices which prohibit or limit eating animal products and/or animal by-products such as veganism or plant-based diets can also contribute to the development of vitamin B12 deficiency, as animal products are the chief source of dietary vitamin B12. Any intestinal procedure that reduces the absorptive capacity of the stomach or intestines, such as bariatric surgery (including gastric sleeve, partial gastrectomy, and gastric bypass) or surgical procedures that remove large portions of the intestines as a treatment for malignancy or other disease can also result in vitamin B12 deficiency either due to actual loss of the tissue that produces intrinsic factor or an impaired or reduced ability to absorb nutrients. Medications can also contribute to the development of vitamin B12 deficiency. Antacids, H2-receptor antagonists, Proton-Pump Inhibitors (PPIs), and metformin can all impair the body's ability to absorb vitamin B12 from dietary sources. If the replacement of vitamin B12 is being accomplished using an oral replacement agent, taking an ascorbic acid supplement within one hour of taking the vitamin B12 supplement can result in the destruction of the vitamin B12. Patients taking oral replacement therapy should be counseled to spread out the administration of these two supplements by at least several hours. 

44.

Your 30-year-old patient presents with joint stiffness and swelling involving bilateral hands and knees, along with malaise and weight loss. These symptoms would prompt you to include which of the following laboratory tests into your plan of care?

  • Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)

  • Gram stain and culture of synovial fluid

  • Serum uric acid levels and C-reactive protein (CRP)

  • 24-hour urine collection and erythrocyte sedimentation rate (ESR)

Correct answer: Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)

The symptoms described are characteristic of rheumatoid arthritis (RA), which involves inflammation of the synovial fluid. The laboratory tests of ESR and CRP are nonspecific tests of inflammation that are frequently elevated in RA but not diagnostic of the condition. The more elevated the results, the greater intensity and degree of the inflammatory process. In osteoarthritis (OA), ESR and CRP levels are typically normal.

Gram stain and culture of synovial fluid would be done to rule out monoarticular septic arthritis in the presence of gout symptoms. Serum uric acid levels are related to the diagnosis of gouty arthritis. There is no indication for a 24-hour urine collection when diagnosing RA.

45.

You need to collect a urinalysis on your 5-year-old female patient whom you suspect has a urinary tract infection (UTI) based on symptoms. Which of the following methods yields a urine specimen that is least likely to be contaminated in this patient? 

  • Suprapubic bladder aspiration

  • "Clean catch" method

  • Urine collection bag

  • Transurethral bladder catheterization

Correct answer: Suprapubic bladder aspiration

The method of obtaining a urinalysis in younger children (younger than 5 to 6 years old) has been long debated. The best method for collecting a urine specimen that is the least likely to be contaminated is via suprapubic bladder aspiration. However, this is an invasive procedure that is likely to cause fear/anxiety in both the parent and child and requires specialized provider skill.

Transurethral bladder catheterization is the next acceptable method for collecting a non-contaminated urine sample. It may be indicated when suprapubic bladder aspiration is not successful or unable to be obtained. 

The "clean catch" method is the best noninvasive method but can be difficult to obtain with younger or pre-toilet-trained children. Use of urine collection bags or sanitary pads offer additional noninvasive methods of collection. However, these methods likely have a high rate of skin or fecal contamination. 

46.

A 45-year-old male patient presents to your office with a complaint of new-onset sexual dysfunction. He reports he has been happily married for 20 years with a satisfying sex life and has not experienced similar symptoms in the past. He describes noticing a decline in his libido and erectile dysfunction several times over the last couple of months. Upon reviewing his chart, you note he started treatment for depression three months ago after being laid off from work six months ago.

You recognize his current symptoms are likely a result of treatment with:

  • Citalopram (Celexa).

  • Mirtazepine (Remeron).

  • Buproprion (Wellbutrin).

  • Trazodone (Desyrel).

Correct answer: Citalopram (Celexa).

Celexa is a selective serotonin reuptake inhibitor (SSRI), which is indicated for treatment of depression. Sexual dysfunction, including decreased libido, anorgasmia, and erectile dysfunction, are common side effects of treatment with SSRIs. Their use is often associated with sexual dysfunction in both genders.

Mirtazapine (Remeron) does not cause sexual dysfunction. Bupropion (Wellbutrin) is associated with increased libido. Trazodone (Desyrel) is associated with increased libido in women and carries a 1 in 6000 risk of priapism (prolonged and painful erection lasting longer than 30 minutes). 

47.

A 25-year-old female patient who was examined by a nurse practitioner (NP) one month ago and diagnosed with migraines returned to the clinic complaining of no improvement in the headaches. The NP started the patient on a beta blocker at the previous visit and confirmed that she had been taking the medication as directed. In addition, the patient had been compliant in eliminating all the lifestyle triggers for the migraines. 

What is the next best step for the NP to take to manage these migraine headaches?

  • Instruct the patient to continue taking the beta blocker as directed and return in another month.

  • Discontinue the beta blocker and switch the patient to a tricyclic antidepressant (TCA).

  • Continue the beta blocker and add ergotamine/caffeine medication.

  • Discontinue the beta blocker and switch the patient to a calcitonin gene-related peptide (CGRP) inhibitor; administer the first subcutaneous dose in the office today and instruct the patient to return in 3 months for the next dose. 

Correct answer: Instruct the patient to continue taking the beta blocker as directed and return in another month.

Making lifestyle modifications to eliminate or minimize migraine triggers is the first step in treating migraines. Ensuring adequate sleep, hydration, and a healthy diet that is free from or limits the ingestion of trigger foods is vital to the management of migraines and tension-type headaches. Medications such as hormonal contraceptives and vasodilators can also contribute to headache frequency; when possible, the offending drug should be discontinued and an alternative medication should be prescribed. 

For patients who qualify for a prescription for preventive or prophylactic medications as treatment for their migraines, counseling about how the medication works is key to patient compliance with taking the medication. Most of the preventive-type medications prescribed for migraine prophylaxis (e.g., beta blockers, antiepileptic drugs, TCA drugs, SNRI drugs) take between 1 and 2 months before showing any effect on the frequency of migraine headaches. Before discontinuing or adding any additional medication to the patient's arsenal, the NP should encourage the patient to wait the full expected time that may be required for the drug to take full effect. 

48.

You are performing an examination on a patient with symptoms consistent with acute appendicitis. Which of the following laboratory test results would you anticipate?

  • Total white blood cell count 12,000/mm3, neutrophils 70%

  • Total white blood cell count 9,000/mm3, band count 3%

  • C-reactive protein 2.0 mg/dL

  • Erythrocyte sedimentation rate 20 mm/hr

Correct answer: Total white blood cell count 12,000/mm3, neutrophils 70%

The most typical White Blood Cell (WBC) count pattern in acute appendicitis is that of a "left shift," consisting of leukocytosis and neutrophilia, as seen with a total WBC count of 12,000/mm3 and neutrophils 70%.

Bandemia may also be seen in acute appendicitis, but a total WBC count of 9,000/mm3 and band count 3% fall within the range of normal for these tests. A normal C-reactive protein level, such as 2.0 mg/dL, rules out the diagnosis of acute appendicitis. An elevated erythrocyte sedimentation rate indicates inflammation; however, an ESR of 20 mm/hr is a normal finding.

49.

A nurse practitioner (NP) counseled an obese patient (BMI >40) who tearfully expressed their desire to lose weight. The patient shared that most of their close family members are also overweight or obese and that in their culture, being overweight or obese is considered to be a positive characteristic. The patient eats fast food almost every day, purchases prepared foods from the grocery store due to not knowing how to cook, and only drinks soda or other sugary beverages. The patient has never engaged in regular physical exercise, enjoying primarily sedentary activities from the time the patient was young. When the patient has been required to take medications in the past, they had a hard time remembering to take medications as prescribed. 

Which of the following changes recommended by the NP is the patient most likely to have difficulty implementing?

  • Adding regular physical activity to their lifestyle

  • Making changes to their diet

  • Taking daily medication to control blood sugar

  • Cutting soda and switching to drinking primarily water

Correct answer: Adding regular physical activity to their lifestyle

When counseling patients who are seeking help for obesity or for being overweight, NPs need to consider all the factors that may influence a patient's ability to achieve weight loss. Diet and lifestyle changes—such as preparing fresh foods at home, getting rid of soda and other sugary beverage choices, adding regular physical activity, and adopting a more active lifestyle—are among the first steps that should be recommended as the patient begins their weight loss. The NP should help the patient set reasonable goals rather than allowing the patient to flounder or enact extreme changes that are not easily maintained. 

A patient whose close family members or significant other are obese or overweight may be at risk of having little or limited support in meeting their weight-loss goals, or they may be less inclined to implement needed diet and lifestyle changes. Pharmacologic methods of weight loss are valuable adjuncts for patients who need to lose a significant amount of weight, but these methods are unlikely to aid weight loss if the patient is non-compliant with taking the medication as directed or consistently inconsistent in taking the medication. All these factors can significantly impair an individual's ability to be successful at losing weight, but the factor that could be the most difficult is the addition of consistent physical activity to their lifestyle. 

50.

You are providing prenatal care for a 29-year-old female who is 32 weeks' gestation. She complains today of lower leg pain and swelling, and reports that she and her spouse recently returned from visiting her parents, who live 4 hours away by car.

You are concerned that the patient may have developed deep vein thrombosis (DVT). Which is the MOST accurate test to evaluate for DVT during the third trimester of pregnancy?

  • Magnetic resonance imaging (MRI)

  • Compression duplex ultrasound

  • Contrast venography

  • D-dimer levels

Correct answer: Magnetic resonance imaging (MRI)

DVT risk is greatest in pregnant women beginning during late pregnancy through the first 6 weeks postpartum, as a result of increased adherent properties of platelets.

During pregnancy, compression duplex ultrasound is the initial test of choice, though it is less accurate for detecting pelvic DVT compared to extremity DVT. While it is most commonly used to diagnose the presence of a deep vein thrombosis (DVT), during the second or third trimester of pregnancy, MRI is more accurate detecting DVT due to alterations in venous flow caused by the gravid uterus. If the results from compression ultrasound testing are abnormal, then further evaluation with MRI is warranted, as it is more accurate. 

While contrast venography is highly accurate at detecting DVT and has been the standard for many years, it is expensive, invasive, and adds a risk of contrast allergy to the patient undergoing the procedure.

D-dimer levels are elevated in individuals with DVT, but need to be correlated with MRI findings and are not used for independent diagnosis of DVT.

51.

While performing a routine check-up of a 45-year-old female patient, she mentions that she is experiencing numbness and pain affecting her hand, forearm, and wrist that awakens her at night.

Which of the following additional findings would you expect to observe?

  • The patient experiences loss of grip, wherein things slip from her fingers without her noticing.

  • Numbness exists predominantly in the fifth finger, extending to the thenar eminence.

  • There is also pain in the epicondylar region of the elbow and upper arm.

  • Symptoms are often most severe in the morning.

Correct answer: The patient experiences loss of grip, wherein things slip from her fingers without her noticing.

The symptoms described (numbness and pain affecting the hand, forearm, and wrist that awakens the patient at night) are consistent with Carpal Tunnel Syndrome (CTS). Among the most common complaints related to CTS, patients will reveal that their hands fall asleep or that things slip from their fingers without their noticing.

Numbness existing predominantly in the fifth finger or extending to the thenar eminence or dorsum of the hand should suggest other diagnoses. Pain in the epicondylar region of the elbow and upper arm is more likely to be due to other musculoskeletal diagnoses. The symptoms of CTS are often worse at night rather than in the morning.

52.

Your elderly patient with diabetes presents with symptoms x1 day of foul-smelling green drainage from the ear and associated severe pain and itching. His voice is hoarse, and he has difficulty swallowing. 

Which medication would you include in your plan of care?

  • Oral ciprofloxacin

  • Oral amoxicillin

  • Polymyxin B with neomycin and hydrocortisone otic drops

  • Ciprofloxacin with dexamethasone otic drops

Correct answer: Oral ciprofloxacin

The signs and symptoms described are consistent with malignant otitis externa, an infection that affects the external auditory canal and temporal bone, commonly seen in elderly patients with diabetes (or in immunocompromised individuals). 

In more than 95% of cases, the causative organism is Pseudomonas aeruginosa. While intravenous (IV) ciproflaxin is the first-line treatment for malignant otitis externa, oral Ciprofloxacin can be prescribed for very early infection, along with a prompt Ear, Nose, and Throat (ENT) consult. 

Oral amoxicillin is not an effective medication for malignant otitis externa, as Pseudomonas bacteria is not sensitive to it. Topical therapy delivered as otic drops, such as polymyxin B with neomycin, and hydrocortisone or ciprofloxacin with dexamethasone are indicated for the treatment of acute bacterial otitis externa. However, the severity of malignant otitis externa warrants systemic antibiotics.

53.

A 55-year-old male patient with no known drug allergies has been diagnosed with community-acquired pneumonia (CAP). The patient was recently treated with ceftriaxone (Rocephin, Epicephin) for sinusitis. Which of the following information is relevant related to a risk for a drug-resistant S. pneumoniae infection?

  • Comorbidity with diabetes mellitus

  • Exposure to second-hand smoke

  • Antimicrobial therapy 4 months ago

  • Patient age > 55 years

Correct answer: Comorbidity with diabetes mellitus

Diabetes mellitus places this patient at increased risk for Drug-Resistant S. Pneumoniae (DRSP).

Other risk factors for DRSP include, but are not limited to, patient age > 65 years and the use of an antimicrobial within the past three months. While smoking may contribute to risk, there is no evidence related to exposure to second-hand smoke. The patient's age of 55 years and a history of antimicrobial therapy 4 months before do not increase the risk for DSRP.

54.

When reviewing the DNA testing results for a patient with human papillomavirus (HPV) infection, which of the following findings indicates the need to make a referral for specialty consultation?

  • Human papillomavirus (HPV) type 16

  • Human papillomavirus (HPV) type 11

  • Human papillomavirus (HPV) type 40

  • Human papillomavirus (HPV) type 61

Correct answer: Human papillomavirus (HPV) type 16

Not all human papillomavirus (HPV) types are correlated with malignancy. However, anal, penile, and cervical carcinomas are associated with types 16, 18, 31, 33, 35, 39, and 45. Over 99% of cervical cancer is attributed to HPV infection as well as about 90% of anal cancers, 70% of oropharyngeal cancers, and 60% of penile cancers. Because type 16 is associated with a higher risk for cancer, a referral for specialty consultation is appropriate.

Benign, often self-limiting disease with a low malignancy risk is seen with infection from HPV types 6, 11, 40, 42, 43, 44, 54, 61, 70, 72, and 81. More than 90% of genital warts are caused by types 6 and 11.

55.

Recognizing that patients with type 2 diabetes mellitus (T2DM) are typically asymptomatic at onset, which of the following is recommended by the American Diabetes Association (ADA) to be completed every three years for all adults, regardless of the appearance of risk, to enhance the chances for a timely diagnosis?

  • Fasting plasma glucose screening

  • Glycosylated Hemoglobin A1C screening

  • Oral glucose tolerance test

  • Random plasma glucose testing

Correct answer: Fasting plasma glucose screening

The ADA recommends periodic Fasting Plasma Glucose (FPG) screening every three years for all adults, regardless of the appearance or risk.

The rationale for this testing interval is that T2DM is unlikely to develop in a three-year interval if the initial glucose was normal. Testing should be considered at a younger age or be done more frequently in individuals with an acquisition of T2DM risk factors. Factors associated with increased risk for T2DM include:

  • A family history of diabetes
  • Overweight
  • Unhealthy diet
  • Physical inactivity
  • Increasing age
  • High blood pressure
  • Pre-diabetes
  • African American, Hispanic American, Asian American, Native American, or Pacific Islander ethnicity
  • Polycystic Ovary Syndrome (PCOS)

56.

When performing an examination on a patient reporting elbow pain, which information would be relevant to a suspected diagnosis of lateral epicondylitis?

  • Pain is located on the outer aspect of the lower humerus.

  • Range of motion in the elbow is restricted.

  • Pain is increased with wrist flexion and with pronation of the forearm.

  • The elbow is significantly reddened and edematous.

Correct answer: Pain is located on the outer aspect of the lower humerus.

The painful condition that arises as a result of injury to the extensor tendon at the lateral epicondyle is called "tennis elbow" or lateral epicondylitis. The condition causes pain over the lateral epicondyle and/or the outer aspect of the lower humerus (outside of the elbow that sometimes radiates to the forearms). The hand grip is often weak on the affected side, but elbow range of motion is usually normal. 

Pain that increases with wrist flexion and pronation of the forearm (gripping activities) is associated with medial epicondylitis. The patient complains of pain over the medial epicondyle or inner aspect of the lower humerus. Redness and swelling are rarely seen.

57.

An examination of a patient with mitral valve prolapse reveals unexplained weight loss, tenderness of the spleen, fever, and Osler's nodes. Which of the following conditions is most likely the cause of these symptoms?

  • Infective endocarditis

  • Lyme disease

  • Infectious mononucleosis

  • Hypertrophic cardiomyopathy

Correct answer: Infective endocarditis

Infective endocarditis is an infection of the inner lining of the heart, most commonly occurring in persons with damaged heart valves, prosthetic heart valves, or other heart defects. Signs and symptoms can vary, depending on the causative pathogen. The most common signs and symptoms include fever, chills, a new or altered heart murmur, fatigue, aching joints and muscles, shortness of breath, edema, persistent cough, unexplained weight loss, hematuria, tenderness of the spleen, Osler's nodes, and petechiae.

Osler's nodes, which are subcutaneous red and painful nodules on the finger pads, are not typically seen in Lyme disease, infectious mononucleosis, or hypertrophic cardiomyopathy.

58.

A concerned mother took her college-aged daughter to the family practice office after she learned her daughter had adopted a strict vegan diet since going away to college. The mother verbalized concern to the provider that her daughter would become sick as a result of the strict diet change and specifically mentioned concern that her daughter would develop pernicious anemia. Which of the following statements made by the Nurse Practitioner (NP) to the concerned parent most accurately explains the risk of pernicious anemia for patients who adopt a strict vegan diet?

  • "Your daughter is unlikely to develop pernicious anemia unless she continues this strict diet practice for over five years."

  • "Your daughter is at a significant risk of developing pernicious anemia in the next year as a result of her dietary choices."

  • "Pernicious anemia is highly associated with adopting a strict vegan lifestyle. Let's talk about starting your daughter on a vitamin B12 replacement in the next month if it seems like she is going to stick with this diet."

  • "People who decide to adopt a strict vegan diet are unlikely to experience pernicious anemia as most of them are able to meet their dietary needs for vitamin B12 through the addition of seeds and nuts to their diet."

Correct answer: "Your daughter is unlikely to develop pernicious anemia unless she continues this strict diet practice for over five years."

Most patients who develop pernicious anemia, vitamin B12 deficiency, do so as a result of impaired absorption of dietary vitamin B12 due to underlying disease processes that interfere with the production of intrinsic factor by the gastric parietal cells. Intrinsic factor is a glycoprotein that binds to dietary vitamin B12 and is transported with it (during the process of digestion) into the terminal ileum, where vitamin B12 is absorbed. This process can also be impaired as the result of removing portions of the stomach or intestines during surgeries such as bariatric surgery or with ileocecal resection in patients with Crohn's disease. 

Rarely is pernicious anemia caused solely by strict changes in the diet, although individuals who adhere to a strict vegan or plant-based diet may develop pernicious anemia if they stick with the dietary changes for a long period. An overabundance of vitamin B12 is naturally stored within the liver to be used for the synthesis of DNA, fatty acids, and myelin when needed. Only a small amount of vitamin B12 is required for these critical processes, making it unlikely that an individual who adheres to a strict vegan diet would experience a deficiency unless they had continued with the strict diet changes for over five years. 

59.

You are reviewing patient education materials for a patient recently undergoing treatment related to uric acid renal stones. Which of the following statements by the patient indicates a need for additional education?

  • "I should continue to eat a high-protein diet every day."

  • "I should drink 67 to 100 ounces of fluid each day."

  • "Water and citrus drinks are the best fluids to choose to help prevent more stones."

  • "I should limit my intake of purine-rich foods."

Correct answer: "I should continue to eat a high-protein diet every day."

Uric acid renal stones form when urine is persistently acidic. These stones form in people who do not drink sufficient fluids or who lose too much fluid, including overdiuresis, eat a high-protein diet, or have gout. Purines derived from animal protein, including certain shellfish and organ meats, in the diet can cause elevated levels of uric acid in the urine. 

Proper hydration is the best method to prevent renal stones. The recommended intake is 2 to 3 liters, or 67 to 100 ounces, per day. Water and citrus drinks are the preferred fluid choices. Dietary restrictions may interfere with getting enough calcium from dietary sources. If calcium supplements are used, they should be taken with meals. Dietary purines can cause elevated levels of uric acid in the urine, contributing to the formation of uric acid renal stones.

60.

Your patient presents to the medical clinic with symptoms suggestive of a potential diagnosis of reactive arthritis (ReA). Which of the following information guides the diagnostic process related to the identification of reactive arthritis?

  • At least one musculoskeletal finding is required to meet the diagnostic criteria for the condition.

  • Most people with the condition are human leukocyte antigen B27 (HLA-B27) negative.

  • Rheumatoid factor analysis is usually markedly elevated in this condition.

  • Estimated sedimentation rate is particularly sensitive for the condition.

Correct answer: At least one musculoskeletal finding is required to meet the diagnostic criteria for the condition.

Diagnostic testing is aimed at finding the underlying cause, such as appropriate bacterial urethral or urine testing or stool cultures. Two or more of the following findings are required to make the diagnosis of ReA with at least one musculoskeletal finding needed:

  • Asymmetrical oligoarthritis
  • Sausage-shaped finger
  • Toe or heel pain or other enthesitis
  • Cervicitis
  • Prostatitis
  • Acute diarrhea within one month of onset of the arthritis
  • Conjunctivitis or uveitis
  • Genital ulceration or urethritis
  • Joint pain, especially in the knees and ankles, and the feet are often involved.

When reactive arthritis is seen with urethritis, there is a male predominance of 9:1 with most being human leukocyte antigen B27 (HLA-B27) positive rather than negative. Laboratory tests for the rheumatic disease, such as AntiNuclear Antibody (ANA) and rheumatoid factor analysis, are not affected by the disease. Estimated Sedimentation Rate (ESR) is elevated because this is an inflammatory condition, but it is not particularly sensitive or specific for the condition.

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