{"id":11219,"date":"2026-10-14T00:05:10","date_gmt":"2026-10-14T08:05:10","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=11219"},"modified":"2026-09-17T14:01:29","modified_gmt":"2026-09-17T22:01:29","slug":"usmle-step-2-ck-question-of-the-day-joint-effusion","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-joint-effusion","title":{"rendered":"USMLE\u00ae Step 2 CK Question of the Day:\u00a0Joint effusion"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_86 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-joint-effusion\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\" >The correct answer to today\u2019s USMLE\u00ae Step 2 CK Question is\u2026<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-joint-effusion\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-joint-effusion\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-joint-effusion\/#Major_Takeaway\" >Major Takeaway<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-joint-effusion\/#Want_to_learn_more_about_this_topic\" >Want to learn more about this topic?<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-2-ck-question-of-the-day-joint-effusion\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em style=\"\"><b>A\u00a047 year old man\u00a0is\u00a0brought\u00a0to\u00a0the\u00a0ER for\u00a0evaluation\u00a0of\u00a0<\/b><\/em><strong><em><strong>left knee pain<\/strong><\/em><\/strong><em style=\"\"><b>\u00a0for\u00a0three\u00a0days. Do you know the best, next step in evaluating his condition? Let&#8217;s find out!<\/b><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A <strong>47-year-old man<\/strong> presents to the emergency department with <strong>left knee pain for 3 days<\/strong>. He reports no recent trauma or injury. His <strong>medical history includes obesity, hypertension, gout, and diabetes mellitus. <\/strong>Temperature is 38\u00b0C (100.4\u00b0F), blood pressure is 145\/70 mmHg, pulse is 111\/min, respiratory rate is 16\/min, and oxygen saturation is 98% on room air. Physical examination demonstrates diffuse swelling, erythema, warmth, and tenderness of the left knee. Flexion and extension are markedly limited because of severe pain. Patellar tap testing is positive for a joint effusion. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Which of the following is the <em>best next step<\/em> in evaluation?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Discharge with outpatient orthopedic follow-up<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Plain radiography of the left knee<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Venous duplex ultrasonography of the left lower extremity<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D. Arthrocentesis with synovial fluid analysis<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. MRI of the left knee<\/strong><\/p>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><em>Scroll down for the correct answer!<\/em><\/p>\n\n\n\n<figure class=\"wp-block-embed is-type-video is-provider-youtube wp-block-embed-youtube wp-embed-aspect-16-9 wp-has-aspect-ratio\"><div class=\"wp-block-embed__wrapper\">\n<iframe loading=\"lazy\" title=\"Learn with Osmosis\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/iDxHtjjCMbU?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe>\n<\/div><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_2_CK_Question_is%E2%80%A6\"><\/span>The correct answer to today\u2019s USMLE\u00ae Step 2 CK Question is\u2026<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">D. Arthrocentesis with synovial fluid analysis<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Correct:<\/strong> See Main Explanation.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Discharge with outpatient orthopedic follow-up<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> This patient requires urgent evaluation because septic arthritis can rapidly cause permanent joint destruction and systemic infection. He should not be discharged for routine outpatient follow-up before the effusion has been evaluated.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B. Plain radiography of the left knee<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Plain radiography may be useful when a fracture, osteoarthritis, or another bony abnormality is suspected. However, it is not the initial diagnostic test in a patient with an atraumatic, febrile knee effusion. Arthrocentesis is needed to evaluate the joint fluid.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C. Venous duplex ultrasonography of the left lower extremity<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> Venous duplex ultrasonography is indicated when deep vein thrombosis is suspected. It is not the initial test for an acutely inflamed knee with a joint effusion.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E. MRI of the left knee<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong> MRI may be useful for evaluating ligamentous or meniscal injuries, osteomyelitis, or soft-tissue infection. These conditions are not the immediate priority in a patient with findings concerning for septic arthritis.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient presents for <strong>evaluation of nontraumatic knee pain with a fever, erythema and warmth over the joint, and a joint effusion<\/strong>. These findings are concerning for septic arthritis but may also represent an inflammatory or crystal-induced arthritis, such as gout. Arthrocentesis with synovial fluid analysis should be performed to distinguish between these possibilities.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Patients with nontraumatic knee pain should first be assessed for an effusion and for signs of septic or inflammatory arthritis.<\/strong> These findings include acute joint swelling, warmth, erythema, fever, systemic symptoms, and severe pain with passive range of motion. <strong>When an effusion is accompanied by these inflammatory features, arthrocentesis should be performed. Synovial fluid analysis should include a cell count with differential, crystal analysis, Gram stain, and bacterial culture.<\/strong> Together, these studies help distinguish septic arthritis from crystal-induced arthropathy, such as gout or pseudogout, and from other inflammatory arthritides.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Patients with nontraumatic knee pain, a joint effusion, and other signs of septic or inflammatory arthritis should undergo arthrocentesis with synovial fluid analysis.<\/strong><\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Want_to_learn_more_about_this_topic\"><\/span>Want to learn more about this topic?<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Watch the Osmosis video: <\/strong><a href=\"https:\/\/www.osmosis.org\/learn\/Approach_to_knee_pain:_Clinical_sciences\">Approach to knee pain: Clinical sciences<\/a><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Bunt CW, Jonas CE, Chang JG. <strong>Knee Pain in Adults and Adolescents: The Initial Evaluation.<\/strong> Am Fam Physician. 2018 Nov 1;98(9):576-585. PMID: 30325638.<\/li>\n\n\n\n<li>Calmbach WL, Hutchens M. <strong>Evaluation of patients presenting with knee pain: Part II.<\/strong> Differential diagnosis. Am Fam Physician. 2003 Sep 1;68(5):917-22. PMID: 13678140.<\/li>\n\n\n\n<li>Chan, B., Crawford, A., Kobes, P. H., Allen, H., Leake, R., Hanrahan, C. J., &amp; Mills, M. K. (2020). <strong>Septic Arthritis: An Evidence-Based Review of Diagnosis and Image-Guided Aspiration.<\/strong> American Journal of Roentgenology, 215(3), 568\u2013581. <a href=\"https:\/\/doi.org\/10.2214\/ajr.20.22773\">https:\/\/doi.org\/10.2214\/ajr.20.22773<\/a><\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image aligncenter size-full\"><a href=\"http:\/\/osmosis.org\/plans\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png\" alt=\"\" class=\"wp-image-5904\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2020\/09\/Blog_Display_Ads_MD1_2023.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"has-text-align-center wp-block-paragraph\"><strong><em>Get your Osmosis from Elsevier <a href=\"https:\/\/www.osmosis.org\/plans\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>&nbsp;now to discover why millions of clinicians and caregivers love learning by Osmosis<\/em>!<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>A 47-year-old presents with severe atraumatic knee pain, swelling, fever, and limited range of motion. Which next step will best clarify the cause of this acute joint presentation?<\/p>\n","protected":false},"author":208,"featured_media":11222,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,20,16,1366,1370,45],"tags":[3443,2967,489,3108,3446,440,1258,3445,3444,2917,84,3206,462,798,952],"class_list":["post-11219","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-exam-prep","category-do","category-questions","category-step-2-questions","category-step-2","tag-acute-monoarthritis","tag-board-exam-prep","tag-clinical-reasoning","tag-clinical-vignette","tag-diagnostic-evaluation","tag-emergency-medicine","tag-gout","tag-inflammatory-arthritis","tag-joint-effusion","tag-knee-pain","tag-medical-education","tag-musculoskeletal-medicine","tag-osmosis","tag-septic-arthritis","tag-usmle-step-2-ck"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - 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