Calcium pyrophosphate deposition disease (pseudogout) Quiz: Ace Your Exams

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A 72-year-old man presents to the clinic with a 2-day history of severe left knee pain and swelling. He has not had any recent trauma, but recalls multiple similar, though less severe, episodes in his wrists bilaterally that have resolved with NSAIDs. Past medical history includes hypertension and type 2 diabetes mellitus for which he takes lisinopril and metformin. Temperature is 37.0°C (98.6°F), blood pressure is 145/85 mm Hg, heart rate is 78/min, respiratory rate is 16/min, and oxygen saturation is 98% on room air. The left knee is warm and swollen with limited passive and active range of motion due to pain. Left knee x-ray shows chondrocalcinosis. Joint aspiration is performed. Which of the following is most likely to be seen in synovial fluid analysis?

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Turbid synovial fluid with positively birefringent rhomboid-shaped crystals

Frank pus and gram-positive cocci in clusters

Bright red synovial fluid with red blood cells

Clear synovial fluid with white blood cell count under 2,000 microL

Turbid synovial fluid with negatively birefringent needle-shaped crystals