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A 65-Year-Old Man Comes to the Office for Evaluation of New-Onset

question 343

Multiple Choice

A 65-year-old man comes to the office for evaluation of new-onset pain in the right knee. The patient first noticed the pain 3 weeks ago after a long hike in the mountains. The pain has not improved with acetaminophen, and he is now unable to sleep because of it. He has also had intermittent low-grade fevers. The patient has Paget disease of bone, which was diagnosed 10 years ago, and type 2 diabetes mellitus. He drinks alcohol socially but does not use tobacco or illicit drugs. Temperature is 37.2 C (99 F) , blood pressure is 120/70 mm Hg, and pulse is 80/min. BMI is 23 kg/m². The right knee has diffuse soft tissue swelling and a small effusion with no surrounding erythema. The distal aspect of the thigh is tender to palpation. X-ray of the right knee reveals medullary and cortical bone destruction with lucent areas and a surrounding periosteal elevation along the distal femur. Which of the following is the most likely cause of this patient's knee pain?

Definitions:

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A type of fat found in the blood, used by the body for energy, but high levels can increase the risk of heart disease.

Contingency Management

A behavioral therapy technique that rewards individuals for desired behaviors to increase the frequency of those behaviors.

Cognitive Behavioral Therapy

A form of psychotherapy that treats problems and boosts happiness by modifying dysfunctional emotions, behaviors, and thoughts.

SBIRT

Screening, Brief Intervention, and Referral to Treatment; a comprehensive, integrated, public health approach to the delivery of early intervention and treatment services for persons with substance use disorders, as well as those who are at risk of developing these disorders.