#january2020mccqe1
A 67-year-old man is evaluated in the office for acute right knee pain that developed 6 days ago after working on his car. The pain is worse when he walks or climbs stairs and improves when he rests. He has no fever and denies knee stiffness. He has minimal pain relief with maximal dosage of acetaminophen and the application of ice. He has no other medical illness and takes no medications. On examination, his temperature is 36.8°C (98.2°F), blood pressure is 132/75 mm Hg, heart rate is 92/min and respiratory rate is 14/min. BMI is 27. Moderate valgus deformity of both knees is present. The right knee has a moderate effusion without warmth or erythema. Pain is elicited with passive and active range of motion. The remainder of his examination is normal. Plain radiographs of his left knee show severe medial joint space narrowing with subchondral sclerosis and osteophyte formation. Analysis of the synovial fluid reveals 1100 leukocytes/μL (1.1 × 109/L) (79% lymphocytes, 10 % macrophages). Which of the following is the best management for this patient's knee pain?
(A) Begin a nonsteroidal anti-inflammatory drug
(B) Begin empiric antibiotics
(C) Inject intra-articular corticosteroids
(D) Obtain right knee magnetic resonance imaging (MRI)
(E) Refer for total knee arthroplasty
A 67-year-old man is evaluated in the office for acute right knee pain that developed 6 days ago after working on his car. The pain is worse when he walks or climbs stairs and improves when he rests. He has no fever and denies knee stiffness. He has minimal pain relief with maximal dosage of acetaminophen and the application of ice. He has no other medical illness and takes no medications. On examination, his temperature is 36.8°C (98.2°F), blood pressure is 132/75 mm Hg, heart rate is 92/min and respiratory rate is 14/min. BMI is 27. Moderate valgus deformity of both knees is present. The right knee has a moderate effusion without warmth or erythema. Pain is elicited with passive and active range of motion. The remainder of his examination is normal. Plain radiographs of his left knee show severe medial joint space narrowing with subchondral sclerosis and osteophyte formation. Analysis of the synovial fluid reveals 1100 leukocytes/μL (1.1 × 109/L) (79% lymphocytes, 10 % macrophages). Which of the following is the best management for this patient's knee pain?
(A) Begin a nonsteroidal anti-inflammatory drug
(B) Begin empiric antibiotics
(C) Inject intra-articular corticosteroids
(D) Obtain right knee magnetic resonance imaging (MRI)
(E) Refer for total knee arthroplasty
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