USMLE Forum Archives - USMLE Step 2 CK - IM- Knee Pain
IM- Knee Pain
HIV - 01-02-08 16:37
A 40-year-old man comes to the office because of pain in his right knee for the past three days. The patient denies fever, vomiting, or dysuria. He has no history of trauma but admits to prior episodes of pain, especially after binge drinking. It usually occurs in the knee, ankle, or big toe and is relieved somewhat by ibuprofen. He takes no medications and has no allergies. He has a 25-pack-year smoking history and drinks about half a case of beer when hanging out with friends. His mother developed the same symptoms at the age of 50. On examination, the right knee appears swollen, red, and tender to palpation and has a limited range of motion. You decide to aspirate the knee joint. Which of the following is most consistent with his diagnosis?
(A) Positively birefringent, rhomboid-shaped crystals and 200 white cells/μL
(B) Bipyramidal crystals and 2,000 white cells/mL
(C) Negatively birefringent, rhomboid-shaped crystals and 20,000 white cells/μL
(D) Cloudy and watery fluid with weakly positive birefringent crystals and 20,000 white cells/μL
(E) Watery fluid with strongly negative birefringent crystals and 20,000 white cells/μL
HIV - 01-02-08 16:37
A 40-year-old man comes to the office because of pain in his right knee for the past three days. The patient denies fever, vomiting, or dysuria. He has no history of trauma but admits to prior episodes of pain, especially after binge drinking. It usually occurs in the knee, ankle, or big toe and is relieved somewhat by ibuprofen. He takes no medications and has no allergies. He has a 25-pack-year smoking history and drinks about half a case of beer when hanging out with friends. His mother developed the same symptoms at the age of 50. On examination, the right knee appears swollen, red, and tender to palpation and has a limited range of motion. You decide to aspirate the knee joint. Which of the following is most consistent with his diagnosis?
(A) Positively birefringent, rhomboid-shaped crystals and 200 white cells/μL
(B) Bipyramidal crystals and 2,000 white cells/mL
(C) Negatively birefringent, rhomboid-shaped crystals and 20,000 white cells/μL
(D) Cloudy and watery fluid with weakly positive birefringent crystals and 20,000 white cells/μL
(E) Watery fluid with strongly negative birefringent crystals and 20,000 white cells/μL
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#1
Re: im TheOne - 01-04-08 01:25 (E) Watery fluid with strongly negative birefringent crystals and 20,000 white cells/μL.
#2
Re: IM- Knee Pain laparotomy - 01-06-08 13:58 E most closely shows the answer. But I would do a CBC and other bloods before I attack the poor mans joint.
#3
Re: IM- Knee Pain 8401glacieres - 01-08-08 10:34 It's Gouty arthritis.
Aspirate would reveal NEGATIVELY BIFRINGENT RHOMBOID SHAPED CRYSTALS.
#6
Re: IM- Knee Pain bingousmle - 06-30-10 20:54 Negatively birefringent, rhomboid-shaped crystals and 20,000 white cells/μL as the scenario described is mostly gouty arthritis
#7
Re: IM- Knee Pain babbu5508 - 07-10-10 03:01 (C) Negatively birefringent, rhomboid-shaped crystals and 20,000 white cells/μL ....picture consistent with gouty arthritis aggravated by alcohol
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