NBME 1 B1 Q 35, kindly explain thanks everyone - irvinedawg

[ArchivalUser]

35. A previously healthy 4-year-old girl is brought to the physician because of fever and refusal to walk for 1 day. She appears mildly ill. Her temperature is 38.6 C (101.5 F), pulse is 120/min, and respirations are 22/min. The right knee is erythematous and swollen. She holds her right knee in flexion and resists any attempted movement of her right leg. She cries when the right knee is moved. Which of the following is the most appropriate next step in management?

A) Acetaminophen with codeine therapy

B) Arthrocentesis

C) Bone marrow aspiration

D) Bone scan

E) Immobilization and traction

F) Lyme titer

G) MRI of the spine

H) Physical therapy

I) Reassurance

J) Serum rheumatoid factor assay

K) Systemic antibiotic therapy

[ArchivalUser]

B) Arthrocentesis

[ArchivalUser]

can u explain please?

thanks in advance

[ArchivalUser]

K?
wbc >50,000 will help Dx septic arthritis, but won't help us much to find the cause immediately as fluid from the joint will not stains so well on Gram stains. If we send for culture we will have to wait for a week or two?

[ArchivalUser]

You may be right dream....Therapeutic arthrocentesis and antibiotics together...Just checked
Arthrocentesis may be preferred in this situation.... it will relieve swelling and remove bacteria acutely.