#march2020mccqe1
A 28-year-old woman presents with painful swelling of her right hand and fingers of 2 days’ duration. She has a low-grade fever and is currently menstruating. She denies a past history of sexually transmitted diseases. On examination, her temperature is 38.6 C (101.4 F), blood pressure is 130/70 mm Hg, pulse is 110/min, and respirations are 20/min. The digits on her right hand are swollen and held in mild flexion, with papules and vesicles in the web spaces. Her left knee and ankle are swollen and tender to touch. Laboratory evaluation shows:
Leukocytes 12,000 with 86% neutrophils
Hemoglobin 14.0 g/dL
Platelets 220,000/mm3
Erythrocyte sedimentation rate 43 mm/h
X-ray films of the hand, knee, and ankle show no evidence of fracture. Which of the following tests is most likely to confirm the likely diagnosis?
(A) Cultures of cervix, rectum, throat, and blood
(B) Blood cultures
(C) Arthrocentesis for bacterial cultures
(D) Synovial fluid analysis for cell count
(E) Synovial fluid Gram stain
A 28-year-old woman presents with painful swelling of her right hand and fingers of 2 days’ duration. She has a low-grade fever and is currently menstruating. She denies a past history of sexually transmitted diseases. On examination, her temperature is 38.6 C (101.4 F), blood pressure is 130/70 mm Hg, pulse is 110/min, and respirations are 20/min. The digits on her right hand are swollen and held in mild flexion, with papules and vesicles in the web spaces. Her left knee and ankle are swollen and tender to touch. Laboratory evaluation shows:
Leukocytes 12,000 with 86% neutrophils
Hemoglobin 14.0 g/dL
Platelets 220,000/mm3
Erythrocyte sedimentation rate 43 mm/h
X-ray films of the hand, knee, and ankle show no evidence of fracture. Which of the following tests is most likely to confirm the likely diagnosis?
(A) Cultures of cervix, rectum, throat, and blood
(B) Blood cultures
(C) Arthrocentesis for bacterial cultures
(D) Synovial fluid analysis for cell count
(E) Synovial fluid Gram stain
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