WBR0209

Author	[[PageAuthor::Mugilan Poongkunran M.B.B.S [1]]]
Exam Type	ExamType::USMLE Step 3
Main Category	MainCategory::Primary Care Office
Sub Category	SubCategory::Musculoskeletal/Rheumatology, SubCategory::Infectious Disease, SubCategory::Musculoskeletal/Rheumatology
Prompt	[[Prompt::23 year old female presents to the office with 5 day history of joint pain and fever. She says has tried over the counter ibuprofen and had only mild relief of her symptoms. Her past medical history is insignificant. She does not smoke or drink. She is sexually active and uses condoms. Physical examination shows hyperemia and swelling in the left knee. Range of movements is restricted because of pain. No rash is present. Arthrocentesis done shows a turbid fluid with WBC count of 60,000/mm3. You make a diagnosis of infectious arthritis. Which additional finding would help in determining the cause of the condition?]]
Answer A	AnswerA::Utricarial skin rash
Answer A Explanation	[[AnswerAExp::Incorrect : Patients with hepatitis B infection may develop fever, chills, polyarthritis, tenosynovitis, and rash. However, the rash associated with acute Hepatitis B infection is typically urticarial, and synovial fluid analysis usually shows noninflammatory fluid. Furthermore, the arthritis associated with hepatitis B is more often polyarticular and symmetric.]]
Answer B	AnswerB::Subcutaneous skin nodules
Answer B Explanation	AnswerBExp::'''Incorrect''' : Subcutaneous nodules are typical of rheumatoid arthritis which are symmetrical and bilateral joint pain.
Answer C	AnswerC::Painful tendons along ankle and toes
Answer C Explanation	AnswerCExp::'''Correct''' : A triad of tenosynovitis, dermatitis, and polyarthralgias without purulent arthritis or purulent arthritis without associated skin lesions is one of the presenting syndromes of disseminated gonococcal infection
Answer D	AnswerD::Sausage digits
Answer D Explanation	[[AnswerDExp::Incorrect : Patients with the constellation of reactive arthritis, tenosynovitis, and urethritis (formerly Reiter syndrome), unlike those with typical DGI, also have one or more of the following: conjunctivitis; circinate balanitis; or keratoderma blenorrhagicum]]
Answer E	AnswerE::Back pain and restriction of movements
Answer E Explanation	[[AnswerEExp::Incorrect : Reiter syndrome also have one or more of the following: conjunctivitis; circinate balanitis; or keratoderma blenorrhagicum]]
Right Answer	RightAnswer::C
Explanation	[[Explanation::Patients with disseminated gonococcal infection (DGI) typically present with one of two syndromes. A triad of tenosynovitis, dermatitis, and polyarthralgias without purulent arthritis or purulent arthritis without associated skin lesions. Patients with either of the above clinical syndromes usually do not simultaneously manifest signs and symptoms of a gonococcal infection involving mucous membranes, even though localized infection involving the urethra, cervix, rectum or pharynx typically precedes the onset of DGI. Other manifestations such as endocarditis, meningitis and osteomyelitis can also occur. Educational Objective: References: ]]
Approved	Approved::Yes
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