Step 2

Rheumatology 8

A 52-year-old man presents to the emergency department with sudden onset of severe pain, redness, and swelling in his right great toe. He reports that the pain started last night and has progressively worsened. He denies fevers or any trauma to the affected toe. He has a history of hypertension and obesity and takes lisinopril with hydrochlorothiazide. He drinks four beers per week and does not smoke cigarettes. Vital signs are within normal limits. On physical examination, the right first metatarsophalangeal joint is erythematous, warm, and extremely tender to touch. Laboratory tests reveal a normal complete blood count (CBC) and elevated serum uric acid level. Arthrocentesis of the affected joint is performed.

Which of the following findings is most likely to be observed in the synovial fluid?

  • A) Calcium pyrophosphate dihydrate crystals with positive birefringence
  • B) Gram-positive cocci
  • C) Needle-shaped monosodium urate crystals with negative birefringence
  • D) Oval fat bodies
  • E) Red blood cells

Author(s)

Dr. Ted O'Connell

Editor(s)

Dr. Ted O'Connell

Last updated

Nov 11, 2024

Our Other Products: