A 35-Year-Old Man Comes to the Office Due to Right

question 61

Multiple Choice

A 35-year-old man comes to the office due to right knee pain over the last 2 weeks.  The patient recently started running to lose weight and runs approximately 15 miles a week.  He has since developed inner right knee pain, making it difficult to climb stairs.  The pain is most intense at night when he is trying to fall asleep.  Medical history is unremarkable, and he takes no medications.  The patient does not use alcohol, tobacco, or illicit drugs.
The patient's temperature is 36.5 C (97.7 F) , blood pressure is 120/70 mm Hg, and pulse is 75/min.  His BMI is 31 kg/m².  There is no knee swelling.  Localized tenderness is noted at the medial aspect of the right knee, 1 inch below the joint line.  While stabilizing the right thigh, lateral movement of the lower right leg elicits no knee pain or medial joint space movement.  His gait is normal.  The remainder of the physical examination is within normal limits.
Which of the following is the most appropriate next step in management?

• A)Activity restriction, knee protection, and ice
• B)Erythrocyte sedimentation rate and rheumatoid factor tests
• C)Glucocorticoid injection
• D)MRI of the knee
• E)X-rays of knee

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