09-11-2009, 08:44 PM
A28-year-old male, well known to your clinic, presents
for management of swelling, pain, and tenderness
that has developed in his left ankle and right
knee. It has persisted for 1 month. Your patient
reports that he developed severe diarrhea after a
picnic 1 month prior to the onset of his arthritis.
During the interval between the diarrhea and onset
of arthritis, he developed a œpink eye that lasted
for 4 days. He denies any symptoms of back pain or
stiffness. You remember that he was treated with
ceftriaxone and doxycycline for gonorrhea 2 years
ago, which he acquired from sexual activity with
multiple partners. Since that time, he has been in a
monogamous relationship with his wife and has not
had any genitourinary symptoms. He promises that
he has been faithful to his wife and has not engaged
in unprotected sexual activity outside his marriage.
His physical examination is notable for a swollen
left ankle, swollen right knee, and the absence of
penile discharge or any skin lesions.
1. Which of the following is the most likely
diagnosis?
(A) pseudogout
(B) gout
© reactive arthritis
(D) resistant gonococcal arthritis
(E) ankylosing spondylitis
2. What would be the appropriate management
for this patient™s arthritis?
(A) Screen him for the suspected disease
with HLA-B27 testing.
(B) Treat with daily indomethacin
(150“200 mg daily).
© Start him on empiric antibiotics.
(D) Start treatment with prednisone 10 mg
daily.
(E) Assume that the patient is not being
honest and perform the appropriate
urogenital testing to confirm gonorrhea.
3. The patient™s symptoms do not respond to your
initial therapeutic management. You suspect
that his condition is refractory to treatment.
Which of the following should you consider at
this time?
(A) He may have human immunodeficiency
virus (HIV) infection and should be
tested.
(B) His condition will require high doses of
prednisone (60 mg daily) for adequate
control.
© His joints are obviously not infected and
should be directly injected with
corticosteroids.
(D) He must have a disseminated bacterial
infection that will require IV antibiotics.
(E) He is resistant to indomethacin, so the
dose should be doubled to 400 mg daily
for management of swelling, pain, and tenderness
that has developed in his left ankle and right
knee. It has persisted for 1 month. Your patient
reports that he developed severe diarrhea after a
picnic 1 month prior to the onset of his arthritis.
During the interval between the diarrhea and onset
of arthritis, he developed a œpink eye that lasted
for 4 days. He denies any symptoms of back pain or
stiffness. You remember that he was treated with
ceftriaxone and doxycycline for gonorrhea 2 years
ago, which he acquired from sexual activity with
multiple partners. Since that time, he has been in a
monogamous relationship with his wife and has not
had any genitourinary symptoms. He promises that
he has been faithful to his wife and has not engaged
in unprotected sexual activity outside his marriage.
His physical examination is notable for a swollen
left ankle, swollen right knee, and the absence of
penile discharge or any skin lesions.
1. Which of the following is the most likely
diagnosis?
(A) pseudogout
(B) gout
© reactive arthritis
(D) resistant gonococcal arthritis
(E) ankylosing spondylitis
2. What would be the appropriate management
for this patient™s arthritis?
(A) Screen him for the suspected disease
with HLA-B27 testing.
(B) Treat with daily indomethacin
(150“200 mg daily).
© Start him on empiric antibiotics.
(D) Start treatment with prednisone 10 mg
daily.
(E) Assume that the patient is not being
honest and perform the appropriate
urogenital testing to confirm gonorrhea.
3. The patient™s symptoms do not respond to your
initial therapeutic management. You suspect
that his condition is refractory to treatment.
Which of the following should you consider at
this time?
(A) He may have human immunodeficiency
virus (HIV) infection and should be
tested.
(B) His condition will require high doses of
prednisone (60 mg daily) for adequate
control.
© His joints are obviously not infected and
should be directly injected with
corticosteroids.
(D) He must have a disseminated bacterial
infection that will require IV antibiotics.
(E) He is resistant to indomethacin, so the
dose should be doubled to 400 mg daily