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A 65-year-old patient who recently underwent abdominal surgery for a diverticular abscess is referred for right knee pain and swelling for 2 days. Physical examination reveals a temperature of 38.3 degrees Celsius and heart rate of 105 bpm. A clinical photograph, results of synovial fluid analysis, and a polarizing microscopy image are seen in Figures A through C. Synovial fluid gram stain and cultures are pending. What is the most appropriate next step in management?
Obtain an MRI of the knee
Begin allopurinol therapy alone
Begin empiric intravenous antibiotics
Give an intraarticular steroid injection
Obtain a rheumatology consult
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A 55-year-old male has severe knee pain and swelling for 2 days. He denies nausea, vomiting, fevers, or chills. On exam, the patient has an erythematous knee with a large effusion. He has pain with attempted range of motion. Radiographs are unremarkable. WBC, CRP, and ESR are within normal limits. The knee was aspirated and the WBC count was 20,000. A specimen from the aspirate is seen in Figure A. What is the next best step in treatment?
Begin empiric antibiotics
Begin oral NSAIDs
Begin treatment with allopurinol
Emergent irrigation and debridement of the knee
Obtain serum uric acid level
A 60-year-old man has had intermittent pain in his right great toe for the past 2 years. What is the most likely cause for the lesions shown in Figure A?
Monosodium urate crystal deposition
Calcium pyrophosphate deposition
Which of the following foot radiographs is most consistent with the diagnosis of gout?