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A 62-year-old white male presents with a chief complaint of right knee pain and swelling. Past medical history is significant for obesity with a body mass index (BMI) of 34 kg/m2, diet-controlled type 2 diabetes mellitus, and hypertension. His medications include hydrochlorothiazide and acetaminophen as needed for pain. Physical examination is remarkable for a moderate-size effusion of the right knee, with range of motion limited to 90° of flexion and 160° of extension. There is minimal warmth and no redness. He has crepitus with range of motion. With weight bearing, he has outward bowing of the legs bilaterally. A radiogram of the right knee shows osteophytes and joint space narrowing. Which of the following is the most likely finding on joint fluid examination?
A. A Gram stain showing gram-positive cocci in clustersB. A white blood cell count of 1110/mm3
C. A white blood cell count of 22,000/mm3
D. Positively birefringent crystals on polarizing light microscopy
E. Negatively birefringent crystals on polarizing light microscopy
Answer
Category: Orthopedics MCQs



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