A 27-Year-Old Man Comes to the Emergency Department Due to Severe

question 113

Multiple Choice

A 27-year-old man comes to the emergency department due to severe left knee pain and swelling for the past 2 days.  He has no recent injury or significant medical problems.  The patient drinks 3 or 4 cans of beer daily but does not use tobacco or illicit drugs.  He works as a groundskeeper at a nearby golf course and has had to take the last couple of days off because of the pain.  Temperature is 38.3 C (101 F) , blood pressure is 115/70 mm Hg, and pulse is 92/min.  On examination, the left knee is swollen, erythematous, warm, and tender with restricted range of active and passive motion.  The remainder of the examination is unremarkable.  Which of the following is the best next step in management of this patient?

• A)Ibuprofen and follow up in 3 days
• B)MRI of the knee joint
• C)Radionuclide bone scan
• D)Serum uric acid level
• E)Synovial fluid analysis