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 BOF 6

 

   

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BOF: 6

A 45-year-old male presents with a 5-day history of dysuria, increased frequency of micturition and discharge per urethra. He also complains of a painful swollen right knee of one-day duration. He feels unwell and has fever.

He works as a sales representative and has recently been on a business trip to Amsterdam. He admits to having unprotected sex with a prostitute. He smokes 10 cigarettes a day and consumes 30 units of alcohol per week.

On examination he is febrile pulse 90 beats per minute blood pressure 130/80 heart sounds normal with no added sounds, respiratory system no abnormity detectable, abdomen normal. His right knee is swollen, there is evidence of an effusion and range of movement is restricted.

In this patient which of the following investigations would be the most appropriate immediate investigation that will enable you to reach a diagnosis?

a)      Urethral smear for gram stain

b)      Aspiration of knee with gram stain

c)      X-ray sacro-iliac joints

d)      X-ray of knee

e)      ESR

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