#july2020mccqe1
A 62-year-old man presents with complaints of severe pain in his left wrist that he says is episodic and has increased in frequency over the past year. He says that he cannot move the wrist when this happens. His father had similar problems before he died of kidney problems due to diabetes. The patient is also diabetic and is taking insulin. His physical examination is normal, except for the limitation of motion of the left wrist. A CBC is normal, and serum chemistry findings are as follows:
Sodium 139 mEq/L
Potassium 3.9 mEq/L
Chloride 98 mEq/L
Calcium 9.2 mEq/L
Uric acid 4 mg/dL
Synovial fluid analysis reveals a white blood cell count of 32,000/μL with 60% neutrophils. Rhomboid-shaped, positive, birefringent crystals are seen under polarized light. Which of the following is the most likely diagnosis in this patient?
(A) Charcot arthropathy
(B) Degenerative joint disease
(C) Gout
(D) Pseudogout
(E) Rheumatoid arthritis
(F) Septic arthritis
A 62-year-old man presents with complaints of severe pain in his left wrist that he says is episodic and has increased in frequency over the past year. He says that he cannot move the wrist when this happens. His father had similar problems before he died of kidney problems due to diabetes. The patient is also diabetic and is taking insulin. His physical examination is normal, except for the limitation of motion of the left wrist. A CBC is normal, and serum chemistry findings are as follows:
Sodium 139 mEq/L
Potassium 3.9 mEq/L
Chloride 98 mEq/L
Calcium 9.2 mEq/L
Uric acid 4 mg/dL
Synovial fluid analysis reveals a white blood cell count of 32,000/μL with 60% neutrophils. Rhomboid-shaped, positive, birefringent crystals are seen under polarized light. Which of the following is the most likely diagnosis in this patient?
(A) Charcot arthropathy
(B) Degenerative joint disease
(C) Gout
(D) Pseudogout
(E) Rheumatoid arthritis
(F) Septic arthritis
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