A 21-Year-Old Man Comes to the Office Requesting a Refill

question 240

Multiple Choice

A 21-year-old man comes to the office requesting a refill of an opioid medication for new-onset left hip pain.  The pain started 3 weeks ago and was initially only with weightbearing, but has progressively worsened and is now present at rest and overnight.  He has no history of trauma.  Medical history is notable for sickle cell disease with several hospitalizations for acute pain crisis.  His last hospitalization was 3 months ago.  The patient has been taking some leftover opioid pain medications from that hospitalization, in addition to regularly scheduled folic acid and hydroxyurea.  He is sexually active with a new female partner.  The patient does not use alcohol, tobacco, or illicit drugs.  His temperature is 37.2 C (99 F) , blood pressure is 100/70 mm Hg, pulse is 80/min, and respirations are 16/min.  Physical examination reveals no local tenderness, but there is restriction of abduction and internal rotation of the left hip.  The right hip and other joints are normal.  Hip x-rays and erythrocyte sedimentation rate are normal.  Which of the following is the most likely diagnosis?

• A)Bacterial infection of the proximal femur
• B)Gonococcal infection of the synovial fluid
• C)Opioid drug-seeking behavior
• D)Osteonecrosis of the proximal femur
• E)Slippage of the femoral head epiphyseal plate

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Definitions:

Point A

Typically used in graphical analysis to denote a specific point or position within a chart or graph.

Economic Capacity

The maximum output that an economy can produce without big increases in inflation, utilizing fully its resources.

Investment Goods

Long-term assets purchased for the purpose of generating income, including machinery, buildings, and equipment.

Economic Growth

The uptick in the true economic value of goods and services made by an economy, accounting for inflation, as time progresses.