A 60-year-old man has had intermittent pain in his right great toe for the past 2 years. Joint aspiration and crystal analysis shows thin, tapered, needle shaped intracellular crystals that are strongly negatively birefringent. Radiograph demonstrates joint space narrowing of the 1st metatarsophalangeal (MTP) joint with medial soft tissue swelling. What is the most likely cause of this condition?
ATuberculosis
BMonosodium urate crystal deposition
CCalcium pyrophosphate deposition
DRheumatoid arthritis
ESeptic arthritis
A 62-year-old man comes to the physician because of a 1-day history of dull pain and stiffness of the right knee. He takes chlorthalidone for hypertension. Physical examination of the right knee shows a large effusion and mild erythema; range of motion is limited by pain. Arthrocentesis of right knee yields a cloudy aspirate. Gram stain is negative. Analysis of the synovial fluid shows a leukocyte count of 15,000/mm3 and 55% neutrophils. Microscopic examination of the synovial fluid under polarized light shows positively birefringent rhomboid crystals. Further evaluation of this patient is most likely to show which of the following findings?
AChalky nodules on the external ear
BExpression of human leukocyte antigen-B27
CThickening of the synovia at the metacarpophalangeal joints
DCalcification of the meniscal cartilage
EElevation of serum uric acid concentration
A 65-year-old man with chronic myelogenous leukemia comes to the physician because of severe pain and swelling in both knees for the past day. He finished a cycle of chemotherapy 1 week ago. His temperature is 37.4°C (99.4°F). Physical examination shows swelling and erythema of both knees and the base of his left big toe. Laboratory studies show: Leukocyte count 13,000/mm3 Serum Creatinine 2.2 mg/dL Calcium 8.2 mg/dL Phosphorus 7.2 mg/dL Arthrocentesis of the involved joints is most likely to show which of the following?
ACalcium phosphate crystals
BMonosodium urate crystals
CGram-negative diplococci
DGram-positive cocci in clusters
ECalcium pyrophosphate crystals
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