Question - fascia

[ArchivalUser]

Physical examination reveals a thin male in no acute
distress. His temperature is 37.3°C, pulse 100 bpm, and
BP 120/70 mm Hg. Small, nontender, mobile lymph
nodes are palpable in the neck and axillae. There is a
large, warm, erythematous patch with central clearing
at the patient’s left axilla. There is limited range of
motion in his right wrist and left elbow. An effusion is
palpable at the left knee, which is diffusely tender.
If you were to aspirate the patient’s knee, which
of the following would you expect to find in the
synovial fluid?

A) >100,000 WBC/mm3.
B) Predominance of eosinophils.
C) Monosodium urate crystals.
D) Spirochetes.
E) Predominance of polymorphonuclear cells.

[ArchivalUser]

dddd

[ArchivalUser]

B) Predominance of eosinophils.

[ArchivalUser]

The correct answer is E.

This patient is presenting now
with classic features of Lyme disease. If synovial fluid is
obtained in a patient with Lyme arthritis, analysis of
the fluid reveals leukocytes, most commonly polymorphonuclear
cells. Answer A is incorrect. If the synovial
fluid has >100,000 WBC/mm3, you should consider
septic arthritis. Answer B is incorrect because eosinophils
are not the predominant cell in synovial fluid of Lyme
arthritis. Answer C is incorrect because monosodium
urate crystals are observed in gout—an unlikely cause
of this patient’s joint complaints. Answer D is incorrect.
Borrelia burgdorferi spirochetes, the causative
organism in Lyme disease, are not usually observed in
the synovial fluid. Lyme arthritis is thought to be an
autoimmune reaction rather than a direct effect of the
spirochete.

[ArchivalUser]

thx