A 33-Year-Old Woman Comes to the Office Due to a 2-Day

question 367

Multiple Choice

A 33-year-old woman comes to the office due to a 2-day history of severe left knee pain and swelling.  She has had no trauma, pain in other joints, fever, chills, or rash.  The patient has a history of parathyroid adenoma with primary hyperparathyroidism and underwent parathyroidectomy a week ago.  Her other medical problems include moderate persistent asthma, irritable bowel syndrome, and gastroesophageal reflux disease.  The patient does not use tobacco, alcohol, or illicit drugs.  She is married and her only medication is an oral contraceptive.
Temperature is 36.7 C (98 F) , blood pressure is 110/56 mm Hg, pulse is 67/min, and respirations are 14/min.  BMI is 28 kg/m².  Physical examination shows a moderate left knee effusion with warmth, erythema, and tenderness.  Range of motion of the knee is decreased due to pain.
Laboratory results are as follows:

Analysis of synovial fluid from the knee joint shows a leukocyte count of 20,400/mm³ with 80% neutrophils.
Which of the following is the most likely cause of this patient's knee pain?

• A)Acute gouty arthritis
• B)Erosive osteoarthritis
• C)Osteitis fibrosa cystica
• D)Pseudogout
• E)Septic arthritis

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Definitions:

Four-factor Model

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The idea that facial movements can influence emotional experiences, suggesting that smiling can make you feel happier.

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The act of refusing to accept, submit to, believe, or make use of something or someone.