new_n_lost
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Guys i dont Know the Answer to this Question Was hoping if u guys cud help me.
A 62-year-old woman comes to the physician because of severe pain and swelling of her right knee for 1 day. She has no history of joint disease or trauma to the knee. She has hypertension treated with hydrochlorothiazide and type 2 diabetes mellitus treated with glyburide. She is sexually active only with her husband, and they have sexual intercourse one to two times each week. Her temperature is 37 C, blood pressure is 140/84 mm Hg, and pulse is 80/min. Examination of the right knee shows edema, erythema, and exquisite tenderness to light touch; there is an effusion. The remainder of the examination shows no abnormalities. Which of the following is the most likely mechanism of these findings?
A) Immune complex deposition
B) Inflammatory reaction to antisynovial antibodies
C) Inflammatory reaction to monosodium urate crystals
D) Neisseria gonorrhoeae infection
E) Streptococcus pneumoniae infection
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| new_n_lost
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my Guess is that its Gout so C shud be the Answer as the Presentation is Monoarticular extremely tender she is the right age for presentation ( post-menopausal) and has no other symptoms which might Suggest a Gonococcal Arthritis ( no rash or migratory arthralgias. And she is taking a Thiaziade diuretic so it may icrease her chances of having a Gouty Presentation.
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| new_n_lost
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Furthermore, Exquisite Pain is the Cardinal Symptom of Gout the pt feels pain even if a bedsheet is placed on their affected area.
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| me007
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it is symptoms of Neisseria gonorrhea arthritis.
where from - not a q, she is sexually active, that is it
For gout - metatarsophalangeal joint, and there is pain, but swelling?
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| Aashi
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C) Inflammatory reaction to monosodium urate crystals --->the MC joint to be affected is the toe,but that doesnt mean that other joints are not affected-->Knee , ankle , wrist , PIP , DIP are other potential sites..the hx is clear for a precursor for this and that is HCTZ
AND why C is not the answer--->for the same reasons NNL pasted above( + no fever)
Typically pts with N.G septic arthritis comes in with polyarthalgias( multiple small joints) and rash-->can be in the form of vesicles or just purpura
NoN gonococal are usually MONOarticular--->the MCC is STAPH..not given in the options
The ultimate dx ofcourse will come only from arthrocentesis-->chking for crystals, cell count, culture and gram stain---->NG arthritis( dxoc is Culture of the urethra, cervix, rectum, and pharynx )and not arthrocentesis
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| new_n_lost
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Gonococcal Arthritis:-
Bacterial Form = disseminated gonococcal infection (DGI) = Bacteremic form - Classic triad of migratory polyarthritis, tenosynovitis, and dermatitis.
Septic arthritis form = Septic arthritis is characterized by acute arthritis with signs of joint effusion, warmth, tenderness, decreased range of motion, and marked erythema.
Septic arthritis most commonly involves the wrists, hands, knees, elbows, shoulders, and, rarely, the hip. Chronic arthritis with joint destruction is rare with appropriate antibiotic therapy
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| new_n_lost
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Septic Arthrits Signs and symptoms of infection may be muted in people who are elderly, who are immunocompromised (especially those with rheumatoid arthritis), and who abuse intravenous drugs. - The pattern of joint involvement is an extremely important diagnostic feature. Of cases of nongonococcal suppurative arthritis, 85-90% are monoarticular. If the disease affects more than one joint, then S aureus most commonly is implicated. Polyarticular arthritis usually is observed in gonococcal disease, various viral infections, Lyme disease, reactive arthritis, and various noninfectious processes.
- Group B streptococci most commonly infect the sacroiliac and sternoclavicular joints.
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| new_n_lost
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Gout (may mimic septic arthritis and rarely occurs with gonococcal arthritis)
- Acute monoarticular arthritis is the initial presentation of gout in 90% of patients.
- In early gout, usually only 1 or 2 joints are involved. Typically, they are the smaller, lower-extremity joints.
- Podagra (inflammation of the first metatarsophalangeal joint) is the initial joint manifestation involved in 50% of cases. Eventually, it is involved in 90% of cases.
- Podagra is not synonymous with gout. Podagra can be observed in patients with pseudogout, sarcoidosis, gonococcal arthritis, psoriatic arthritis, and reactive arthritis.
- The attacks begin abruptly and reach maximum intensity in 8-12 hours. The joints are red, hot, and exquisitely tender; even a bed sheet on the swollen joint is uncomfortable.
- Untreated, the first attacks resolve spontaneously in less than 2 weeks. Intermittent inflammatory arthritis, in which the joints return to normal between attacks, typically is caused by crystalline disorders and is true of gouty arthritis early in its course.
- Gout can initially present as a polyarticular arthritis in 10% of patients. Elderly women, particularly women with renal insufficiency and taking a thiazide diuretic, often develop polyarticular arthritis as their first manifestation of gout. These attacks may occur in coexisting Heberden and Bouchard nodes. Such patients also may develop tophi more quickly, occasionally without prior episodes of acute gouty arthritis.
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| rock
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agree with gout as the answer...as there is also a clue-->HCTZ
gor gonococcal they will give a more elaborate history of multiple sexual partners or some other risk factor...and plus it will be migratory arthritis and some kinda rash or fever or some other history pointing towards gonococci.
knee is the 2nd most common joint to be affected after gr8 toe in gout.
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| Ig F
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seemz to be gout ....for multiple reasons.a)no fever b)thiazide usage c)post menopausal.......
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