A 36-Year-Old Woman Comes to the Physician with Knee Pain

question 181

Multiple Choice

A 36-year-old woman comes to the physician with knee pain that started 2 weeks earlier.  The pain is localized anteriorly in both knees and is greater in the left.  She moved to a new 2-story house 3 weeks ago and has used the stairs many times.  Lately she has experienced severe pain when ascending or descending the stairs.  The pain also increases after prolonged rest.  The patient has no obvious knee trauma or swelling.  When she tried to run every day 3 months ago, she developed similar symptoms and had to stop.  Her only other medical problem is psoriasis on her elbows, for which she uses corticosteroid and vitamin D combination ointment.
Vital signs are normal.  BMI is 34 kg/m².  There is no joint line tenderness, redness, warmth, or effusion noted in either knee.  Range of motion is normal with mild crepitus.  Directly compressing the patella while the leg is extended elicits pain.  Valgus and varus stress testing are normal.  Lachman, McMurray, and anterior and posterior drawer tests are normal.
Which of the following is the best next step in management?

• A)Bracing
• B)Corticosteroid injections
• C)Methotrexate
• D)MRI of both knees
• E)Physical therapy

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Definitions:

Genetic Differences

Variations in the genes among individuals or populations, which contribute to the biological diversity.

Personality Differences

Variations among individuals in regards to enduring patterns of thinking, feeling, and behaving.

Hofstede's Dimensions

A framework for cross-cultural communication, developed by Geert Hofstede, that describes the effects of a society's culture on the values of its members.

Cultural Personality

A term that may refer to the collective personality characteristics, attitudes, and traits shared by people within a particular culture.