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Old 07-09-2011
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Rheumatology/Orthopedics Nun with knee pain and purpura!

A 57 year old catholic nun is admitted to your servie for knee pain for the last 4 days. She has a history of high blood pressure controlled with low sodium diet and exercise. Her vital signs are BP: 130/80 HR: 75 T 37.9 RR 16. On physical exam you find tenderness of both knees, decreased mobility, pain on range of motion , redness and a few purpuras on the skin. She denies trauma, recent surgery, diabetes, gout and arthritis history. Which of the following is the most likely cause of this patient's condition?

A. Staphylococcus Aureus
B. Streptococcus Pneumoniae
C. Rickettsia
D. Neisseria Gonorrhea
E. Polymicrobial
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Old 07-09-2011
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staphylococcus aureus. i remember seeing a question similar to this one in Kaplan Qbook
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Old 07-09-2011
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A................
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Old 07-09-2011
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why staph?
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Old 07-09-2011
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A. Staphylococcus Aureus
septic arthritis
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Old 07-09-2011
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no trauma...arthritis recent onset...no history of anything in particular..>I would say gonorrhea but it doesnt fit...Although Staph is logical but there is no history of trauma...I 'd have to go with polymicrobial by some other route
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Old 07-09-2011
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For, s.aureus ...i think should have some history of direct knee trauma, skin trauma or any joint hematogenous spread... i'd like to go for > D. Neisseria Gonorrhea

Last edited by dryogi; 07-10-2011 at 12:34 AM.
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Old 07-09-2011
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Staph causes monoarthritis this is possibly DGI. I go for gonococci
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Old 07-10-2011
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Quote:
Originally Posted by amirh899 View Post
Staph causes monoarthritis this is possibly DGI. I go for gonococci
why? if it's hematogenously spread, then it can still be bilateral, and at that age, there can be early stages of osteoarthritis not yet symptomatic in the form of pain, and damaged joints predispose to staph too.
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Old 07-10-2011
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ιi m with d
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Old 07-11-2011
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Quote:
Originally Posted by cool_atomic View Post
staphylococcus aureus. i remember seeing a question similar to this one in Kaplan Qbook
How come its staph when she denies history of trauma and its bilateral knees affected??
Shudnt it be N.Gonorrhea?
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Old 07-11-2011
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The correct answer is D. Gonorrhea, just because she is a nun does not rule out gonorrhea. We should ask sexual activity .
Gonococcal arthritis is polyarticular in 50 % of cases with tendynosynovitis very common, effusions are less common and skin manifestations with petechiaes are also common.
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