daira
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A 27-year-old actor presents with a swollen left knee. The pain began 36 hours earlier and has limited his ability to perform in his current play. He has had a fever and shaking chills over the past 24 hours. Physical examination reveals a temperature of 38.9 C (101.9 F) and a pulse of 104/min. The remainder of the physical examination is unremarkable except for a swollen, erythematous knee with an obvious effusion. There is limited range of motion. An arthrocentesis reveals 90,000/mm3 white blood cells and 82% neutrophils. A Gram's stain reveals many neutrophils, and no organisms are seen. Polarizing microscopy reveals no crystals. Which of the following is the most appropriate initial step in therapy?
A. Ceftriaxone
B. Colchicine
C. Indomethicin
D. Nafcillin
E. Nafcillin and ceftriaxone
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| usmleasr
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gonococcal ? so ceftrioxone i guess
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| mdwannabe
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Ceftrxn
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| asmi
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gonococcal...ceftriaxone
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| daira
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Answer given is E.
Reason given is: as casative organism is not clear, so its better to treat both NG and Staph Aureus (though NG is more common in this age and without any predisposing joint damage).
comments?
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| asmi
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I c
Good Q
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| bronco
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THE ABSCENCE OF ORGANISM (CLUSTER COCCI) GOES MORE TO ONLY GONORRHEA (USUALLY NOT SEEN)
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| Anil Kumar980
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I agree with daira on two counts:
1.It could be gono
2.It could be a mixed infn in which case a combo is needed.
As far as I know u start off on a combo and till you know for sure by Gm stain or culture u dont use a single drug unless history has some real evidence supporting gone.
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| bactitech
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Just curious why you would treat with Nafcillin, considering most Staphylococcus aureus is resistant to penicillins, and a huge percentage are now methicillin resistant also.
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| bactitech
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I have looked at gram stains from many knee fluids. One very rarely sees organisms on the direct smear, regardless of what eventually grows.
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