MKSAP: 72-year-old man with acute swelling and severe pain of the right knee
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 72-year-old man is evaluated in the emergency department for acute swelling, severe pain, and warmth of the right knee that woke him from sleep. He does not recall any inciting injury to the knee. Three months ago, he had an acutely swollen great toe that improved within 3 days, for which he did not seek treatment. History is also significant for hypertension and diabetes mellitus. Medications are hydrochlorothiazide and metformin.
On physical examination, temperature is 37.8 °C (100.1 °F), blood pressure is 130/75 mm Hg, pulse rate is 90/min, and respiration rate is 12/min. BMI is 33. The right knee is warm and swollen without overlying erythema; tenderness to palpation and decreased range of motion due to pain are noted. There is no skin breakdown or abrasions over the right knee. Examination of the other joints is unremarkable.
Which of the following is the most appropriate next step in management?
A. Obtain a knee MRI
B. Obtain a serum urate level
C. Perform joint aspiration
D. Start empiric colchicine
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Source: Kevin, M.D. - Medical Weblog - Category: Journals (General) Authors: mksap Tags: Conditions Rheumatology Source Type: blogs
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