Aashi
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A 27-year-old woman seeks the advice of her primary medical doctor because of progressive swelling of the right knee. She also complains of mild rectal discharge and pain in her wrists and ankles. She is afebrile. She has some mild pharyngeal injection, and the lungs and abdomen are normal. There is no rash evident. Examination of the lower extremities reveals an erythematous and edematous right knee with tenderness over the tendon sheaths of the ankles and wrists. Which of the following procedures is most likely to yield a diagnosis in this patient?
(A) Arthrocentesis and culture of the synovial fluid
(B) Blood culture
(C) Gram stain of the synovial fluid
(D) Cervical Gram stain
(E) Culture of the urethra, cervix, rectum, and pharynx
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| prathapdoctor
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culture of urethra,cervix,rectum and pharynx.
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| CocaCola
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A - Arthrocentesis and culture of synovial fluid
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| vanshita
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A
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| anjushree
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gonnococcal arthritis-----jt and skin lesion are immune mediated-----so culture is negative
ans----culture of Cx,rectum,urethra and pharynx
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| robin082006
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E
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| MHP
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E
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| Aashi
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Answer:
(E) Culture of the urethra, cervix, rectum, and pharynx
Explanation:
Dissemination of gonococcal infection occurs from the site of inoculation via the bloodstream. There is an association with menstruation, pregnancy, and C6 through C9 terminal complement deficiency. Disseminated gonococcal infection presents with intermittent fevers, arthralgias, joint effusion, and tenosynovitis involving the ankles, backs of hands, and wrists. Skin lesions can range from a maculopapular rash to pustular or petechial lesions. Culture has been the gold standard for diagnosis of gonorrhea, particularly when Gram stain is negative. The Gram stain of cervical discharge is positive with gonorrhea approximately 50% of the time, whereas culture, especially with selective Thayer-Martin media, is positive up to 90% of the time when there is a discharge. The sensitivity of cervical cultures is closer to 30% in disseminated gonorrhea in the absence of discharge. Blood cultures are rarely positive with disseminated gonorrhea (10%) but are more often found to be positive with nongonococcal infectious arthritis, such as from staphylococci or streptococci. Synovial fluid culture and Gram stain are negative early in the course of the illness half of the time in gonococcal disease. Gram stain of a pharyngeal smear is not specific due to the presence of other gram-negative diplococci in the normal oral flora. Because culture of the synovial fluid is so often negative, the best yield is with combining cultures of a number of remote sites, in addition to culturing the joint itself. Although you certainly would perform the joint fluid culture, the point of the question is that a combination of remote site cultures has a greater sensitivity than simply culturing the joint itself.
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