phuluong2k
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20) 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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| ARJ
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E 
Start emperical therapy send for culture
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| DrS
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E
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| bajaj123
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E
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| phuluong2k
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Right, but this is a young patient, i think more about N.gonorrhea, so I choose Ceftriazone.
If in the Q stem say that he is sexually active, do we choose A or E ?
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| DJ walayat
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E
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| DrS
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The most likely organism in this case is N. gonorrhoeae as this is the commonest cause of septic arthritis in previously healthy young adults in the US. However as this cannot be determined wtih certainty in this case, and improper empircal coverage can lead to potentially disastrous consequences it would be advisable to empirically cover both possible organisms even though gonococcal arthritis is more likely.
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