A patient presents to the emergency department with severe pain in their leg, fever, and redness over a recent wound site. The patient reports having an open fracture two weeks ago, which was treated with a cast. Upon examination, the area over the fracture is swollen, warm to the touch, and extremely tender. The patient is also experiencing chills and difficulty bearing weight on the affected leg. Based on these symptoms, which of the following is most likely the diagnosis, and what are the primary signs and symptoms?
Septic arthritis: A joint infection causing redness, warmth, swelling, and pain in the affected joint, often with fever and chills.
Rheumatoid arthritis: A systemic autoimmune disorder causing joint pain, swelling, and stiffness, most common in the hands and feet.
Gout: A form of arthritis caused by the accumulation of uric acid crystals in the joints, leading to sudden, intense pain, often in the big toe.
Osteomyelitis: A bone infection characterized by fever, localized pain, swelling, and warmth at the site of infection.
The Correct Answer is D
Choice A reason: Septic arthritis affects joints, causing joint-specific swelling and pain, but this patient’s symptoms center on a fracture site, suggesting bone involvement. Osteomyelitis better matches pain, swelling, and warmth over a bone wound, with fever and chills, so this is incorrect.
Choice B reason: Rheumatoid arthritis is a chronic autoimmune condition affecting multiple joints, typically hands and feet, not a single fracture site. This patient’s acute fever, localized bone pain, and wound-related symptoms point to osteomyelitis, not systemic arthritis, making this incorrect.
Choice C reason: Gout causes acute joint pain, often in the big toe, due to uric acid crystals, not bone infections. The patient’s fracture site pain, swelling, and systemic symptoms like fever align with osteomyelitis, not gout, so this is incorrect.
Choice D reason: Osteomyelitis, a bone infection, matches the patient’s severe pain, swelling, warmth, and redness over a recent fracture site, with fever and chills. These are primary signs of bone infection post-trauma, making this the correct diagnosis and symptom description.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Gout tophi are urate crystal deposits, typically on joints like the big toe, not widespread on hands. Osteoarthritis nodes (Heberden’s/Bouchard’s) are more common in elderly hands, so this is incorrect.
Choice B reason: Rheumatoid nodules occur in rheumatoid arthritis, usually near elbows, not diffusely on hands. Osteoarthritis nodes are bony growths on finger joints, more likely in this patient, so this is incorrect.
Choice C reason: Osteoarthritis nodes (Heberden’s and Bouchard’s) are bony lumps on finger joints, common in elderly women with joint pain. This matches the hand findings, making it the correct diagnosis.
Choice D reason: Carpal tunnel syndrome causes wrist pain and numbness, not joint lumps. Osteoarthritis nodes explain the hand bumps in this elderly patient, so this is incorrect.
Correct Answer is A
Explanation
Choice A reason: Hyperventilation causes decreased CO2 levels (respiratory alkalosis) due to rapid breathing from pain, anxiety, or restlessness. This matches the patient’s symptoms and blood gas results, making it the correct cause.
Choice B reason: Nephrolithiasis causes pain but doesn’t typically lead to hyperventilation or low CO2. Respiratory alkalosis from hyperventilation better explains the findings, so this is incorrect for the cause.
Choice C reason: Acute fracture causes pain but not necessarily hyperventilation or low CO2. Anxiety-driven hyperventilation is more likely to cause respiratory alkalosis, so this is incorrect for the primary cause.
Choice D reason: Urinary tract infection may cause discomfort but not low CO2 or hyperventilation. Anxiety and pain causing hyperventilation align with the blood gas, so this is incorrect.
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