Q. A 26 yrs old woman presents with 5 day history of fever and joint pain.

Her symptoms
began with wrist and handpain that resolved and then progressed to right knee swelling
and pain.she denies genitourinary symptoms or diarrhea.There is no history of reent
travel!amping or hiking.she is se"ually ative and denies alohol or drug use.
#n e"amination!her temperature is $%2&f and
oropharyn" is without ulers and e"udates.her right knee is swollen with warmth with
pain on fle"ion.the remaining joints are unremarkable.skin e"amination reveals a total of
three 5 to ' mm pustules on the dorsum of her right upper e"tremity and trunk.
( A) *ost onsistent with diagnosis is
$.disseminated gonooemia
2. nongonooal septi arthritis
+.lyme disease
,.reiters syndrome

5.pseudogout
(-)
*ost likely to onfirm the diagnosis

$.*./ of knee
2. synovial fluid ulture
+.synovial fluid gram stain
,.synovial fluid ell ount
5. synovial fluid rystal analysis
A0123.4
(A) .eognise and diagnose gonooal arthritis.Althoughdefinitive diagnosis
re5uires arthoentesis and fluid e"amination!the most ommon ause of
septi arthritis remains gonooal arthritis.this woman has typial
migratory polyartralgia whih settles as monoarthritis.she has no risk
fator for lyme or nongonnooal septi arthritis(i.v drug abuse)reiters
syndrome is harateri6ed by onjuntivitis! arthritis and urethritis.lyme
disease also has typial erythema hroni migrans whih is 57$5 m in
diameter.8seudogout tends to affet older individuals and has no rash.
(-)
The diagnosis is onfirmed by ulturing the organisms suh as synovial fluid
or blood. However synovial fluid is only positive in 5%9 ases of purulent arthritis.gram
stain is rarely positive in gonooal arthritis.synovial fluid rystal analysis will be
negative..*./ is most useful for soft tissue damage suh as menisal tear./ndiret
evidene in this ase would be ervial ulture whih is positive in :%9 of ases.