Kamsi
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A 40-year-old man comes to the office because of pain in his right knee for the past three days. The patient denies fever, vomiting, or dysuria. He has no history of trauma but admits to prior episodes of pain, especially after binge drinking. It usually occurs in the knee, ankle, or big toe and is relieved somewhat by ibuprofen. He takes no medications and has no allergies. He has a 25-pack-year smoking history and drinks about half a case of beer when hanging out with friends. His mother developed the same symptoms at the age of 50. On examination, the right knee appears swollen, red, and tender to palpation and has a limited range of motion. You decide to aspirate the knee joint. Which of the following is most consistent with his diagnosis?
(A) Positively birefringent, rhomboid-shaped crystals and 200 white cells/μL
(B) Bipyramidal crystals and 2,000 white cells/mL
(C) Negatively birefringent, rhomboid-shaped crystals and 20,000 white cells/μL
(D) Cloudy and watery fluid with weakly positive birefringent crystals and 20,000 white cells/μL
(E) Watery fluid with strongly negative birefringent crystals and 20,000 white cells/μL
What's ur ans n diagnosis
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| Justice
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I guess this is one for the Fischer's questions...
Answer is (E)
(C) might also fit Dx of Gout, but the crystals are not rhomboid-shape...
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| elitoki
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this pte has history of possible Gout, and now has again symptos( knee pain). I look up first for Gout (negative birefringent crystals) and the only one that match is E.
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| doc_clotaire
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(E) Watery fluid with strongly negative birefringent crystals and 20,000 white cells/μL
What's ur ans n diagnosis
BIG TIME E 
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| dermatology
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Gout ......... E
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| starcraftbw
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E
gout.....what if patietn can't tolerate NSAID due to having GI bleeding? what would you do?
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| mjl1717
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How would you properly treat this?
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| dr in trouble
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E--gout
Allopurinol is the Rx.
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| mjl1717
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acute gout Rx should be colchicine and/ or indomethacin..
also for allopurinol you want to know if he is an undersecretor or over secretor of uric acid- in order to know if you give probenecid or alllopurinol respectively
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