IT Quiz Answer – September 19, 2024
Answers from our weekly Intelligent Thursday quizzes!
Pop quiz: September 19, 2024
A 58-year-old male with a past medical history of type 2 diabetes mellitus, hypertension, heart failure, and stage 4 chronic kidney disease presents with new onset left knee pain, swelling, restricted range of motion (ROM), and difficulty walking. Symptoms started two nights ago and have gotten progressively worse. He denies any other symptoms.
Answer: D (Intraarticular methylprednisolone, 40 mg)
Explanation:
This patient has gout, which has been confirmed by crystal analysis of the joint synovial fluid. The best option to treat his current flare is with an intraarticular glucocorticoid injection because the knee is the only affected joint and also because this minimizes the risk of systemic side effects such as worsening of his diabetes, hypertension, and heart failure.
Naproxen should not be used in this patient with advanced chronic kidney disease. Colchicine wouldn't be as effective because symptoms started more than 48 hours ago, and the risk of side effects such as vomiting and diarrhea is also higher in those with renal failure. Allopurinol and Febuxostat are not medications that treat acute flares, and in fact, they can worsen flare symptoms. If you need to start these medications during a flare for long-term gout management, make sure the gout flare is being treated adequately.
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