A 3-year-old patient is brought to the emergency department by her mother due to inability to walk. The child has been limping recently and as of this morning, has refused to walk. Any attempts to make the child walk or bear weight result in crying. She was recently treated for impetigo and currently takes a vitamin D supplement. Physical exam is remarkable for an anxious appearing toddler with knee swelling, erythema, and limited range of motion due to pain. Her mother denies any recent trauma to the child's affected knee. Temperature is 103°F (39.4°C), pulse is 132/min, blood pressure is 90/50 mmHg, respirations are 18/min, and oxygen saturation is 99% on room air. Which of the following is the best initial step in management?
AMRI
BUltrasound
CSynovial fluid analysis
DBroad spectrum antibiotics
ERadiograph
A 22-year-old female with no past medical history presents to her primary care physician with a 3-day history of knee pain. She denies any recent injury or trauma. On physical examination her knee is warm, erythematous, and has diminished range of movement. The patient reports having multiple sexual partners over the last year and does not use protection regularly. Her blood pressure is 124/85 mmHg, heart rate is 76/min, and temperature is 38.3℃ (101.0℉). A joint aspiration is performed and a growth of gram-negative diplococci is noted on bacterial culture. What is the treatment of choice for this patient's condition?
AVancomycin monotherapy
BFluoroquinolones
CNafcillin monotherapy and joint aspiration
DOxacillin and ceftriaxone
ECeftriaxone monotherapy and joint aspiration
A 42-year-old woman comes to the emergency department because of worsening severe pain, swelling, and stiffness in her right knee for the past 2 days. She recently started running 2 miles, 3 times a week in an attempt to lose weight. She has type 2 diabetes mellitus and osteoporosis. Her mother has rheumatoid arthritis. She drinks one to two glasses of wine daily. She is sexually active with multiple partners and uses condoms inconsistently. Current medications include metformin and alendronate. She is 161 cm (5 ft 3 in) tall and weighs 74 kg (163 lb); BMI is 29 kg/m2. Her temperature is 38.3°C (100.9°F), pulse is 74/min, and blood pressure is 115/76 mm Hg. She appears to be in discomfort and has trouble putting weight on the affected knee. Physical examination shows a 2-cm, painless ulcer on the plantar surface of the right toe. The right knee is swollen and tender to palpation. Arthrocentesis of the right knee with synovial fluid analysis shows a cell count of 55,000 WBC/μL with 77% polymorphonuclear (PMN) cells. Which of the following is the most likely underlying cause of this patient's presenting condition?
AAutoimmune response to bacterial infection
BHematogenous spread of infection
COccult meniscal tear
DIntra-articular deposition of urate crystals
EDirect inoculation of infectious agent
+ 7 more in the PDF
Browse all chapters