smitha
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A 30 yo woman with acute monoarticular arthritis & has >50,000 WBCs in the synovial fluid without crystals..........wat's the t/t?????
A 72 yo man with RA with the same findings, wat's the t/t?????
A 25yo man with acute pain in rt. knee, has 10,000 WBCs, rhomboid negatively birefringent crystals, wat r the conditions u need to think of.............????????
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| Delusional
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A 30 yo woman with acute monoarticular arthritis & has >50,000 WBCs in the synovial fluid without crystals..........wat's the t/t?????
I would begin empiric treatment to cover Gonnococci and non-gonococci till i get a gram stain at least....
* 3rd Gen Cephalosporin like Ceftriaxone to cover gonococci and G-ve
*Oxacillin to cover Staph aureus
A 72 yo man with RA with the same findings, wat's the t/t?????
I would go for the same empiric treatment but with the Cephalosporin to cover the G-ve and definitely not suspecting gonoorhea
A 25yo man with acute pain in rt. knee, has 10,000 WBCs, rhomboid negatively birefringent crystals, wat r the conditions u need to think of.............????????
Id suspect Gout
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| smitha
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well, all these guys want u to know sometimes, in USMLE, is, how do u differentiate with age presentation, for antibiotic t/t in cases of septic arthritis, until the results for the joint fluid comes back.......
And usually, in young people, as delusional very rightly said, it's usually gonococci & ur t/t of choice if given choice of one drug, shud be ceftriaxone more than oxacillin/oxa/diclox.
And in elderly, it's oxa/cloxa/diclox............if only one drug to be told...
3.......SORRY GUYS & DELUSIONAL, imeant rhomboid positively birefringent crystals & not negatively birefringent!!!!!!! so, plz tell me now, wat cud be the answers!!!!!!1
SORRY agian, for the wrong typing!!!!!!! 
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| Delmar
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"smitha" wrote:
A 30 yo woman with acute monoarticular arthritis & has >50,000 WBCs in the synovial fluid without crystals..........wat's the t/t?????
A 72 yo man with RA with the same findings, wat's the t/t?????
A 25yo man with acute pain in rt. knee, has 10,000 WBCs, rhomboid negatively birefringent crystals, wat r the conditions u need to think of.............????????
1- septic arthritis
2- active RA
3- pseudogout
ttt:
1- Antibiotics
2- methotrexate+predinsone+splint
3-NSAID
___________________
VENI VIDI VICI
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| smitha
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hey let me be clear here.............
1...........this pt. being young, she has septic arthritis, most likely due to gonococci.......Tx: ceftriaxone
2............this pt. is also septic arthriis pt. but older one, so, most likely cause is staph. aureus........Tx: oxa/cloxa/nafcillin vancomycin in resistant cases
3............this pt. is YOUNG , that's the give off guys, plzzzzzzzzzzz look for that, coz this presentation resembling pseudogout , is NOT PSEUDOGOUT as , pseudogout is seen in elderly &/or in pt.s with preexisting jt. ds. and not in such pts. like mine  .
An dso, we can say is there r secondary conditions causing this deposition of negatively birefringent, rhomboid crystals(CPPD)........
They r..........Hyperparathyroidism, Hemachromatosis, Hypomagnesemia, Hypophosphatasia.........
So plzzzzzz remember these " 4Hs".............
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| Visitor
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Could you plz clarify what "you" understand as "Psuedogout"...
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| Visitor
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because the condition is "Really" termed "Pseudogout" and those 4 'H's are the predisposing conditions for "PSEUDOGOUT" esp in a young person.
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| smitha
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hello visitor...
I guess, wat really confused u here is me using "it's not pseudogout"!!!!!!well, i shud've said "it's not a TYPICAL CASE OF PSEUDOGOUT" wherein previous h/o jt. ds or an elderly pt. comes into picture..............hopeu got it now
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| smitha
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source: my pwn qs, reference from kaplan, CMDT
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