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Stem
A 27-year-old man presents with a swollen, painful right knee and left ankle of 4 days' duration. Three weeks earlier he had a self-limiting episode of mucoid diarrhoea after a takeaway meal. He has also noticed burning on urination for a week and a gritty sensation in both eyes. On examination there is an asymmetric oligoarthritis (right knee and left ankle effusions), tenderness at both Achilles tendon insertions, a swollen "sausage" second toe on the left foot, and painless shallow oral ulcers. He is afebrile. He has no significant past history.
Questions
a) What is the most likely diagnosis, and what two features in the history define its timing? (2 marks)
b) List four clinical features that place this in the seronegative spondyloarthropathy family. (3 marks)
c) What investigations would you perform to confirm the diagnosis and identify the trigger? (3 marks)
d) Outline the management, including one sight-threatening complication that needs urgent referral. (2 marks)