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  #1  
Old 09-09-2012
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Rheumatology/Orthopedics A big toe arthritis is not always Gout!

A 17-year-old girl presents to the emergency department with a 2-day history of a painful and swollen right big toe. She also has had a fever, with temperatures up to 38.9 C (102 F), at home for 2 days. On physical examination, her temperature is 101.8 F (38.8 C). Her first metatarsal joint of the right foot is markedly swollen and very painful to touch. An aspirated fluid from the joint reveals a white blood count of 35,000/ mm3. Which of the following is the most likely diagnosis?

a) Juvenile rheumatoid arthritis
b) Gout
c) Lyme disease
d) Pseudogout
e) Septic arthritis

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  #2  
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b gout ..
Site is typical...
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  #3  
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I also thought gout...but its not the correct answer
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  #4  
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I think A is the answer
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i will go for septic arthritis due to high cell count
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They had given septic arthritis as the correct answer .....

but UW and MTB say in septic arthritis the WBC count is > 50000......????
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Quote:
Originally Posted by K06100 View Post
They had given septic arthritis as the correct answer .....

but UW and MTB say in septic arthritis the WBC count is > 50000......????
In KLN page number 44 " consider septic arthritis when wbc count >5000 and mono articular joint involvement.
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  #8  
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this is a good example of how clinical evidence is better than laboratory evidence...

Even though everything points out to gout, gout doesn't give that fever... so infection must be taken into account.
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well infection , alcohol and other stresses can precipitate gout ........

plus wbc less that 50,000 is not septic arthritis plus septic arthritis affects big joint ....... big toe is pretty common for gout and rare for septic arthritis ...

look like gout to me ....... may be the source of the qs is not so reliable ....
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NOT NECESSARY that u have the counts above 50.000 always in septic arthritis........she might have tried some antibiotics at home too, so the count can drop when she presented two days later to ER(just a posisbility)

they did not mention about crystals anywhere in the vignette, so better avoid crystal arthropathies

adolescents----MCC of septic arthritis is gonococcus
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Gonococcal arthritis usually affects large knee and ankle , wrist - Big joint.....On toe ???
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Quote:
Originally Posted by anomali View Post
NOT NECESSARY that u have the counts above 50.000 always in septic arthritis........she might have tried some antibiotics at home too, so the count can drop when she presented two days later to ER(just a posisbility)

they did not mention about crystals anywhere in the vignette, so better avoid crystal arthropathies

adolescents----MCC of septic arthritis is gonococcus

we are not working on assumptions that she had antibiotics and also that she is sexually active ( shes just 17 , though possible but they do mention it in the qs too as having a boy friend....... )


septic arthritis is polyarthritic and affects large joints .......

and uw has mentioned that the wbc count is greater than 50,000 ........ and i would follow it unless all things are pointing to septic arthrits which is not the case here

as the synovial fluid doesnot show crystals it also doesnot show any gram stain results ....... god knows what they did with the synovial fluid ...... only wbc count .........

so the source of the qs appers to be flawed as it tried to make the qs tricky but ended up making no sense out of it .......
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Quote:
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god knows what they did with the synovial fluid ......
haha.....

i think we will not get these kind of questions as USMLE avoids controveries.....In USMLE question will be clear.......
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Quote:
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haha.....

i think we will not get these kind of questions as USMLE avoids controveries.....In USMLE question will be clear.......

anyways where was the qs from ????.....pretty controversial .......
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Quote:
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anyways where was the qs from ????.....pretty controversial .......
when i downloaded UW 2011 from torrents ..it had a folder named kaplan q bank....and there were 22 blocks in it ..and 1 of those blocks had this question.......
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At first I thought its gout, but fever female and young made me think about
Septic arthritis,, but the question isn't complete
They should mention that there where no crystals
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Old 09-13-2012
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i thought septic arthritis since the fever and white count are high..
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Old 09-15-2012
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Quote:
Originally Posted by K06100 View Post
when i downloaded UW 2011 from torrents ..it had a folder named kaplan q bank....and there were 22 blocks in it ..and 1 of those blocks had this question.......
which torrent website?
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  #19  
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Quote:
Originally Posted by saintdizzy View Post
which torrent website?
http://torrentz.eu/
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