An 11-Year-Old Girl Is Brought to the Emergency Department Due

question 300

Multiple Choice

An 11-year-old girl is brought to the emergency department due to right shoulder pain.  The patient first noticed the pain 4 days ago after softball practice.  She has been placing cold compresses over the shoulder and taking acetaminophen with initial improvement, but the pain has awakened her from sleep the last 2 nights.  Today she is unable to lift her right arm to brush her teeth.  Four months ago, the patient was diagnosed with polyarticular juvenile idiopathic arthritis involving the wrists, knees, and ankles.  She is taking methotrexate, and her symptoms had been gradually improving after dose adjustments.  Temperature is 38.5 C (101.3 F) .  The patient holds her right arm at her side, and she resists attempts to move the shoulder due to pain.  The overlying skin is warm.  Bilateral wrists, knees, and ankles are mildly edematous.  The shoulder joint is aspirated, and synovial fluid analysis reveals leukocyte count of 55,000 cells/mm³, with 80% polymorphonuclear cells and 20% lymphocytes.  Which of the following is the best next step in management of this patient?

• A)Add a biologic disease-modifying antirheumatic drug
• B)Administer intra-articular glucocorticoids
• C)Begin antibiotic therapy
• D)Increase methotrexate dose
• E)Recommend nonsteroidal anti-inflammatory drugs and rest

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Definitions:

Freud's Theory

A set of psychoanalytic theories proposed by Sigmund Freud, focusing on unconscious desires, childhood experiences, and stages of psychosexual development.

Lagging Behind

The state or condition of being slower than desired or expected, often used in educational or developmental contexts.

Processes

Encompasses a series of actions, changes, or functions that bring about a result or accomplish an objective.

Developmental Milestones

The developmental sequences and patterns that are predictable in a child’s growth.