USMLE Forum Archives - USMLE Step 2 CK - Peds 15
Peds 15
TheOne - 05-24-07 19:39
A 16 years old girl is brought to the emergency department with a 3 days history of a painful and swollen right big toe. She also has had a fever, with temperatures up to 39 C (103.8 F), at home for 3 days. Her parents decided to bring her to the hospital tonight because she has been unable to sleep due to the pain. On physical examination, her temperature is 101.8 F (38.8 C). Her first metatarsal joint of the right foot is markedly swollen and very painful to touch. An aspirated fluid from the joint reveals a white blood count of 65,000/ mm3. Which of
the following is the most likely diagnosis?
A. Juvenile rheumatoid arthritis
B. Gout
C. Lyme disease
D. Pseudogout
E. Septic arthritis
TheOne - 05-24-07 19:39
A 16 years old girl is brought to the emergency department with a 3 days history of a painful and swollen right big toe. She also has had a fever, with temperatures up to 39 C (103.8 F), at home for 3 days. Her parents decided to bring her to the hospital tonight because she has been unable to sleep due to the pain. On physical examination, her temperature is 101.8 F (38.8 C). Her first metatarsal joint of the right foot is markedly swollen and very painful to touch. An aspirated fluid from the joint reveals a white blood count of 65,000/ mm3. Which of
the following is the most likely diagnosis?
A. Juvenile rheumatoid arthritis
B. Gout
C. Lyme disease
D. Pseudogout
E. Septic arthritis
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#4
Re: Peds 15 nrp - 06-04-07 01:17 I too go for E- Septic arthritis.Systemic manifestations like fever upto 103F is uncommon in gout.
#5
Re: Peds 15 vicman - 06-05-07 06:10 According to the information, it should be gout at first instance. Trauma, surgery or chronic diseases background are almost needed to start thinking on septic arthritis... on the other hand, the patient is too young and pain is the main reason they are asking for help.
#6
Re: Peds 15
TheOne - 06-06-07 18:07 The correct answer is E. Septic arthritis refers to microbial invasion of the synovial space. Pathogens enter the synovial space by either hematogenous spread, local spread from contiguous infection, or a traumatic or surgical infection of the joint space. Accumulating fluid and pus rapidly raise the intraarticular pressure and permanently injure vessels and articular cartilage. More than 90% of cases of septic arthritis affect the joints of the lower extremity, with the knee most commonly involved. Acute septic arthritis is bacterial, with Staphylococcus aureus the most common nongonococcal organism, followed by group A streptococci and Streptococcus pneumoniae. Other organisms to consider vary by age groups. Haemophilus influenzae is common in children younger than 3 years, but the incidence is decreasing with Hib vaccine. Neisseria gonorrhoeae may be isolated in neonates and sexually active adolescents.The teenage girl in this clinical vignette most likely has N. gonorrhoeae. Group B beta-hemolytic streptococci is an important cause in neonates. Sickle cell patients are at risk for Salmonella infection.
Most children with septic arthritis appear ill and present with fever, joint pain, joint swelling, and limited movement of the affected joint. The pain is often severe and constant, with increased pain when the infected joint is moved. On physical examination, the joint is typically flexed to limit motion; local erythema, warmth, and swelling may be present. In septic arthritis of the hip, the joint is often flexed, with slight abduction and external rotation, and limitation of internal rotation with passive motion.
#8
Re: Peds 15 babbu5508 - 07-07-10 00:14 E. Septic arthritis....fever,toe markedly swollen and very painful to touch. An aspirated fluid from the joint reveals a white blood count of 65,000/ mm3.
#9
Re: Peds 15 bingousmle - 07-09-10 14:53 An aspirated fluid from the joint with a white blood count of 65,000/ mm3 plus signs of fever and local findings septic is more likely even if its the big toe
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