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A 20-Year-Old Woman Comes to the Office Due to Atraumatic

question 662

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A 20-year-old woman comes to the office due to atraumatic heel pain over the last week. For the past 6-8 months, the patient has also experienced bilateral hip pain that has progressively worsened and now awakens her during the early-morning hours. When this occurs, she gets up and walks around for a few minutes before going back to sleep. The patient also has difficulty tying her shoelaces in the morning due to back pain and stiffness; however, she does not feel limited when performing other daytime activities. She has tried over-the-counter pain medications and found ibuprofen to be more effective than acetaminophen. A year ago, she had an episode of intense pain, photophobia, and redness involving her left eye, which improved with corticosteroid eye drops. The patient also occasionally has mouth ulcers, usually around the time of her menstrual periods. Family history is significant for breast cancer in her mother and multiple sclerosis in her aunt. The patient does not use tobacco, alcohol, or illicit drugs. She is sexually active and uses oral contraceptives for birth control.
Vital signs are normal. The oral mucosa is moist with mild tonsillar swelling, but there are no ulcers or other lesions. There is tenderness and swelling of the heel, as shown in the exhibit. Examination of the ankle and other joints shows no synovitis or effusion. Flexion and external rotation of the hip joints elicits intense pain at the gluteal region.
Laboratory results are as follows:
Which of the following is the best next step in evaluation of this patient's condition?

Definitions:

Variable Costing

A costing method that includes only variable production costs—direct materials, direct labor, and variable manufacturing overhead—in unit product costs.

Excess Capacity

The amount by which the actual production of a company exceeds its planned production capacity.

Variable Production Costs

Expenses that change in direct proportion to the level of production output.

Cost-Volume-Profit Analysis

An accounting method used to determine how changes in costs and volume affect a company's operating income and net income.