04-17-2014, 09:58 AM
A 40 year old female presents to her physician for worsening joint pain. She has had joint pain for many years in both wrists, MCP joints, and PIP joints. Her DIPs are spared. Her pain is always worse in the morning and improves as the day goes on. Lately she realizes both knees also hurt her and she is more tired than usual. Examination reveals her painful joints to be mildly warm and her PIPs are flexed, while her DIPs are extended. Laboratory testing reveals high titers of rheumatoid factor (RF), an elevated ESR and C- reactive protein, and a normocytic normochromatic anemia. Examination of the synovial fluid at the involved joints would most likely reveal which of the following?
a. Clear fluid; 125 WBC/mm3; 20% PMNs
b. Clear-yellow fluid; 1,800 WBC/mm3; 20% PMNs
c. Cloudy-yellow fluid; 6,000 WBC/mm3; 60% PMNs
d. Turbid, purulent fluid; 50,000 WBC/mm3; 80% PMNs
e. Reddish fluid; 1,500 WBC/mm3; 20% PMNs
a. Clear fluid; 125 WBC/mm3; 20% PMNs
b. Clear-yellow fluid; 1,800 WBC/mm3; 20% PMNs
c. Cloudy-yellow fluid; 6,000 WBC/mm3; 60% PMNs
d. Turbid, purulent fluid; 50,000 WBC/mm3; 80% PMNs
e. Reddish fluid; 1,500 WBC/mm3; 20% PMNs