An 18-Year-Old Woman Comes to the Office Due to 3

question 49

Multiple Choice

An 18-year-old woman comes to the office due to 3 days of right foot pain.  She is a ballet dancer and has been practicing intensely over the last few weeks for an upcoming show.  The patient is under a lot of stress and is worried that the pain may limit her practice sessions.  She has no medical history other than a left tibia stress fracture a year ago.  The patient has irregular menses, and her last menstrual period was 12 weeks ago.  She does not use tobacco, alcohol, or illicit drugs.
BMI is 17 kg/m².  There is focal tenderness over the right fourth metatarsal shaft.  Urine pregnancy test is negative.
Which of the following is the most appropriate next step in management of this patient?

• A)Make an orthopedic referral for surgical repair
• B)Order a CT scan of the foot
• C)Refer for physical therapy
• D)Screen for an eating disorder
• E)Start bisphosphonate therapy

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