#may2020mccqe1
A 66-year-old woman is evaluated because of right knee pain of 4 weeks' duration. Although the knee is stiff for 20 to 30 minutes in the morning, she does not have much pain at work. Walking up the stairs in her house, however, causes a good deal of pain, which is not relieved by ibuprofen or acetaminophen. Kneeling also causes pain. Knee radiographs done 6 weeks ago show mild medial compartment osteoarthritis bilaterally. On physical examination, she is overweight. There is coarse crepitus with flexion and extension of the right knee. Both knees are in slight varus angulation ("bow-legged"). On palpation, there is tenderness along the joint margins of both knees and exquisite tenderness to digital pressure at the medial upper tibia on the right that reproduces her pain. In addition, with the patient's right knee semiflexed, palpation along the medial semimembranous tendinous (hamstring) edge of the thigh elicits pain when the examining fingers meet the tibia. Which of the following is most likely responsible for the exacerbation of the right knee pain?
(A) Anserine bursitis
(B) Gout
(C) Osteoarthritis
(D) Rheumatoid arthritis
A 66-year-old woman is evaluated because of right knee pain of 4 weeks' duration. Although the knee is stiff for 20 to 30 minutes in the morning, she does not have much pain at work. Walking up the stairs in her house, however, causes a good deal of pain, which is not relieved by ibuprofen or acetaminophen. Kneeling also causes pain. Knee radiographs done 6 weeks ago show mild medial compartment osteoarthritis bilaterally. On physical examination, she is overweight. There is coarse crepitus with flexion and extension of the right knee. Both knees are in slight varus angulation ("bow-legged"). On palpation, there is tenderness along the joint margins of both knees and exquisite tenderness to digital pressure at the medial upper tibia on the right that reproduces her pain. In addition, with the patient's right knee semiflexed, palpation along the medial semimembranous tendinous (hamstring) edge of the thigh elicits pain when the examining fingers meet the tibia. Which of the following is most likely responsible for the exacerbation of the right knee pain?
(A) Anserine bursitis
(B) Gout
(C) Osteoarthritis
(D) Rheumatoid arthritis
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