0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Special Feature |

Picture of the Month—Quiz Case FREE

Edmund A. Milder, MD; Jeffrey S. Gerber, MD, PhD, MSCE
[+] Author Affiliations

Author Affiliations: Department of Pediatric Infectious Diseases (Dr Milder), Division of Infectious Diseases (Dr Gerber), The Children's Hospital of Philadelphia; Medical Corps, United States Navy, Naval Reserve Officer Training Corps (Dr Milder), and School of Medicine (Dr Gerber), University of Pennsylvania, Philadelphia.


SECTION EDITOR: SAMIR S. SHAH, MD, MSCE


Arch Pediatr Adolesc Med. 2012;166(11):1065. doi:10.1001/archpediatrics.2012.1687a.
Text Size: A A A
Published online

An 18-year-old woman reported to the emergency department after 2 weeks of having fatigue, poor appetite, and general malaise. She reported no fevers, rhinorrhea, vomiting, diarrhea, or rash. She had 2 days of diffuse joint pains in her upper and lower extremities, particularly in her ankles and wrists. While in the emergency department, she developed severe, acute right wrist pain with swelling, erythema, and warmth. A fluid-filled lesion developed on the dorsum of her right hand (Figure 1 and Figure 2). She was febrile (39.4°C) and tachycardic, with normal respiratory rate and blood pressure. Serum white blood cell count was 8400/mL; hemoglobin level was 9.0 g/dL (to convert to grams per liter, multiply by 10.0; reference range, 12.0-16.0 g/dL); and C-reactive protein level was 6.1 mg/L (to convert to nanomoles per liter, multiply by 9.524). Arthrocentesis of her right wrist revealed purulent fluid (white blood cell count, 95 000/mL).

Place holder to copy figure label and caption
Graphic Jump Location

Figure 1. Photograph showing the fluid-filled lesion on the dorsum of the patient's right hand.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 2. Photograph showing swelling of the patient's right wrist. The adhesive bandage is covering the site where the arthrocentesis was performed.

Figures

Place holder to copy figure label and caption
Graphic Jump Location

Figure 1. Photograph showing the fluid-filled lesion on the dorsum of the patient's right hand.

Place holder to copy figure label and caption
Graphic Jump Location

Figure 2. Photograph showing swelling of the patient's right wrist. The adhesive bandage is covering the site where the arthrocentesis was performed.

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
JAMAevidence.com