USMLEGladiator
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35. A previously healthy 4-year-old girl is brought to the physician because of fever and refusal to walk for 1 day. She appears mildly ill. Her temperature is 38.6 C (101.5 F), pulse is 120/min, and respirations are 22/min. The right knee is erythematous and swollen. She holds her right knee in flexion and resists any attempted movement of her right leg. She cries when the right knee is moved. Which of the following is the most appropriate next step in management?
A
) Acetaminophen with codeine therapy
B
) Arthrocentesis
C
) Bone marrow aspiration
D
) Bone scan
E
) Immobilization and traction
F
) Lyme titer
G
) MRI of the spine
H
) Physical therapy
I
) Reassurance
J
) Serum rheumatoid factor assay
K
) Systemic antibiotic therapy
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| hero
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b
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| drms
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B
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drms!dreams+responsibility+motivation=success!
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| liliaeliz
Forum Elite
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B
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| Sayulita
Forum Guru
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give her something for the pain and fever first
the run other diagnostic lab and antibiotics if necessary
why you guys want to stick a needle in just like that ??
A then K
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| MAB
Forum Senior
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for arthrocentesis you will do local anesthesia....tylenol#3 won't help much..in terms of movement....you need to know first..atleast how does the aspiration material look like before you start the antibiotic and also for culture
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| Oussama77
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So its B). Arthrocentesis
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| ngaybinhyen
Forum Guru
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it sounds like this is not a very clear Q the way they ask. We probably all know we need to r/o septic arthritis in this child.
-t.
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| ngaybinhyen
Forum Guru
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Arthrocentesis
-t.
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| dr.d.r.agicha
Forum Newbie
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B-arthrocentesis
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| GOGETA
Trying to get in PGY1
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First give miadzolam make the patient sleep and quiet then arthrocenetesis
but I would choose B arthro
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| nightflight1945
Forum Guru
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B
) Arthrocentesis
then start Ab Therapy.
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| hitesh
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Arthrocentesis
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2/10
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| omz2302
Forum Newbie
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B - always do arthrocentesis first in ANY swollen joint, especially with fever. Im pretty sure there isnt any exception to this rule. If there is, please correct me. Remember though, i emphasize the word SWOLLEN.
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| ngaybinhyen
Forum Guru
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hey bro,
look for the non-inflamed joint, particularly with FH/o hemophilia
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| omz2302
Forum Newbie
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oh sorry, right. I meant as the first test if there arent any of the regular contraindications like a celluliitis present on the joint or a history of bleeding diathesis.
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| ngaybinhyen
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