A 70-Year-Old Woman Comes to the Office Due to Pain

question 719

Multiple Choice

A 70-year-old woman comes to the office due to pain and redness of the right elbow.  The patient is a freelance writer and recently began writing regularly for a local newspaper.  She first noticed the symptoms 2 days ago when her arm was supported on an arm rest while she used her computer.  The pain has increased and she now feels a "bump" in the area.  She does not recall any trauma to her elbow.  The patient has had occasional knee pain after prolonged walking but no other joint pains.  Medical history is notable for type 2 diabetes mellitus, hypertension, and osteoporosis.
Temperature is 38.3 C (101 F) , blood pressure is 134/84 mm Hg, and pulse is 84/min.  There is a fluctuant swelling on the back of her right elbow with overlying erythema, warmth, and tenderness but passive range of motion is normal.
Leukocyte count is 9,200/mm³, blood glucose is 130 mg/dL, and serum creatinine is 0.8 mg/dL.  Aspiration of the swelling yields 35 mL of clear yellowish fluid with a decrease in size of the swelling.  The nucleated cell count on the fluid is 10,500/mm³.  Gram stain and crystal analysis are negative.
Which of the following is the best next step in management of this patient's condition?

• A)Anti-staphylococcal antibiotic
• B)Intralesional glucocorticoid injection
• C)Nonsteroidal anti-inflammatory drug and joint protection
• D)Oral colchicine therapy
• E)X-ray of the elbow

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Definitions:

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A process through economic innovation in which older models or structures are destroyed to make way for new advancements.

Diffusion

The process by which a technological innovation, cultural trend, or new idea spreads through a population or society.

Innovation

The act of introducing something new or improving an existing product, service, or process to enhance productivity or create value.

Entrepreneurs

Individuals who create new businesses, bearing most of the risks and enjoying most of the rewards.