A 69-Year-Old Man Comes to the Office Due to Severe

question 592

Multiple Choice

A 69-year-old man comes to the office due to severe pain in his left knee for the past 48 hours.  The pain began in the middle of the night.  He has not had trauma, fever, or chills.  He had an episode of pain in his right great toe 3 years ago that he was told was gout.  He was given treatment to prevent a recurrence but has been noncompliant.  Medical history is significant for hypertension, stage 3 chronic kidney disease, and gastroesophageal reflux disease (GERD) .  His current medications are atenolol, fosinopril, and lansoprazole.
He appears to be in mild distress and has difficulty with ambulation.  Temperature is 36.7 C (98 F) , blood pressure is 136/94 mm Hg, pulse is 84/min, and respirations are 14/min.  Cardiovascular, pulmonary, and abdominal exams are unremarkable.  His left knee is tender, warm, and erythematous with a small effusion.  There is decreased range of motion in all aspects.  There are no abnormalities of any other joints.
Laboratory results are as follows:
Plain films of the knee are remarkable only for evidence of degenerative joint disease.
On arthrocentesis of the left knee, a small amount of fluid was obtained with a negative gram stain and 13,000/mm³ white blood cells (50% polymorphonuclear cells) .  Needle-shaped, negatively birefringent crystals are present on polarized microscopy.
Which of the following is the best treatment option for this patient?

• A)Allopurinol
• B)Febuxostat
• C)Indomethacin
• D)Intra-articular corticosteroids
• E)Low-dose colchicine

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Definitions:

Lipid

Substance composed principally of carbon, oxygen, and hydrogen; contains a lower ratio of oxygen to carbon and is less polar than carbohydrates; generally soluble in nonpolar solvents.

Carbohydrate

Monosaccharide (simple sugar) or the organic molecules composed of monosaccharides bound together by chemical bonds—for example, glycogen. For each carbon atom in the molecule, there are typically one oxygen molecule and two hydrogen molecules.

Subcutaneous Fat

The layer of fat located under the skin, serving as insulation to regulate body temperature and as an energy reserve.

Muscle Mass

Refers to the amount of muscle tissue in an individual's body, typically measured in terms of volume or weight.