A 72-Year-Old Retired Plumber Comes to the Office to Discuss

question 427

Multiple Choice

A 72-year-old retired plumber comes to the office to discuss treatment of chronic right knee pain.  Over the past 10 years, the patient has had multiple rounds of glucocorticoid injections and physical therapy to manage the pain, which has increasingly worsened; using a cane, he can now walk only 2 blocks before it becomes unbearable.  Medical history is notable for type 2 diabetes mellitus, hypertension, and depression.  Blood pressure is 130/78 mm Hg and pulse is 80/min.  BMI is 26 kg/m².  On examination, the right knee is stiff and swollen but has no erythema.  There is tenderness on palpation at the medial and lateral joint lines, and patella grind test is positive.  Ligament testing is stable to varus and valgus stress.  Passive and active range of motion is limited because of pain.  X-ray of the right knee shows bicompartmental joint space narrowing and multiple osteophytes.  Which of the following is the best treatment option for this patient?

• A)Arthroscopic meniscectomy
• B)High-dose oral glucocorticoids
• C)Hinged knee brace application
• D)Knee joint aspiration
• E)Long-acting opioid pain medication
• F)Total knee arthroplasty

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Definitions:

Discount Period

The time frame between the onset of a payment period and the due date when a discount for early payment is available.

Perpetual Inventory System

An inventory management system where updates to inventory records are made in real-time with each sale or purchase, providing a continuous record of inventory levels.

Discount Period

The timeframe during which a discount is offered for prompt payment on sales.

Merchandise Sold

The products that a retailer, wholesaler, or distributor has sold to customers during a specific period.