A 63-Year-Old Man with a History of Hypertension, Type 2

question 413

Multiple Choice

A 63-year-old man with a history of hypertension, type 2 diabetes, and severe osteoarthritis underwent a right total knee arthroplasty 3 months earlier.  He comes to his primary care physician with persistent pain and swelling of the right knee.  The patient has pain with activity and at rest, with the most significant pain associated with weight bearing.  He has no fevers, chills, nausea, vomiting, or diarrhea.  He goes to rehabilitation but his participation has been limited over the past week due to persistent pain.
His temperature is 37.1 C (98.7 F) , blood pressure is 114/74 mm Hg, pulse is 86/min, and respirations are 18/min.  Examination shows a moderately swollen right knee with decreased range of motion.  The surgical scar is intact without surrounding erythema.  Examination of the left knee is within normal limits.
An x-ray of the knee reveals an intact prosthesis.  Laboratory tests, including complete blood count, electrolyte panel, C-reactive protein, and erythrocyte sedimentation rate, have been ordered.
Which of the following is the best next step in management of this patient's condition?

• A)Aspiration of the prosthetic joint
• B)Broad-spectrum antibiotic therapy
• C)Magnetic resonance imaging scan of the right knee
• D)Naproxen and close clinical follow-up
• E)Technetium 99m colloid bone scan

---

Definitions:

Actionable Behavior

Conduct that can be the basis for legal action because it violates a legal standard or right.

Emotional Distress

A legal term referring to the mental suffering or anguish induced by an incident of negligence or intentional wrongdoing.

Outrageous Conduct

Behavior by a party that is so extreme or beyond the bounds of decency that it causes shock or offense.

Actionable Behavior

Conduct that gives sufficient legal ground for a lawsuit, identifying behaviors that can lead to legal action.