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A 70-year-old, non–sexually active male complains of fever and pain in his left knee. Several days previously, the patient skinned his knee while working in his garage. The knee is red, warm, and swollen. An arthocente- sis is performed, which shows 200,000 leukocytes/μL and a glucose of 20 mg/dL. No crystals are noted. The most important next step is

  1. Gram stain and culture of joint fluid

  2. Urethral culture

  3. Uric acid level

  4. Antinuclear antibody 


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a. Gram stain and culture of joint fluid