Thank you guys for the replies!:happy::happy::happy::happy::happy:
The purpose of the question is to stress out the importance of WBC numbers in the differential diagnosis of acute monoarthritides. Whilst 2,000-50,000 cells indicate an inflammatory condition, any value above 50,000 is highly indicative of a septic arthritis. It is important to know that gouty flares and septic arthritides can often coexist, as in this patient! The question, cleverly asks about to which condition should you aim your treatment, which is septic arthritis, due to the highly destructive and debilitating nature of the disease. It is better to empirically treat this condition until the culture results show the clear nature of the underlying illness.
Another important issue here is the presence of INTRA-CELLULAR crystals which are more indicative of a gouty flare. If the crystals are EXTRA-CELLULARLY it drives us away from the possibility of an acute gouty flare.
The purpose of the question is to stress out the importance of WBC numbers in the differential diagnosis of acute monoarthritides. Whilst 2,000-50,000 cells indicate an inflammatory condition, any value above 50,000 is highly indicative of a septic arthritis. It is important to know that gouty flares and septic arthritides can often coexist, as in this patient! The question, cleverly asks about to which condition should you aim your treatment, which is septic arthritis, due to the highly destructive and debilitating nature of the disease. It is better to empirically treat this condition until the culture results show the clear nature of the underlying illness.
Another important issue here is the presence of INTRA-CELLULAR crystals which are more indicative of a gouty flare. If the crystals are EXTRA-CELLULARLY it drives us away from the possibility of an acute gouty flare.
