10-08-2010, 08:47 AM
A 56-year-old man presents for evaluation in a primary care clinic. He has a 2-day history of right ankle swelling and pain. He reports experiencing discomfort with ambulation and when driving an automobile. On further questioning, he denies experiencing a recent trauma, although he does recall spraining his ankle approximately 10 years ago. On examination, the patient’s temperature is 99.9° F (37.7° C). His right ankle is warm to palpation and reveals an effusion. With passive range of motion of the right ankle, significant pain is elicited.
Which of the following is the most appropriate step to take next in the treatment of this patient?
A. Check the serum uric acid level; if elevated, initiate therapy with
indomethacin and colchicine
B. Obtain a plain radiograph of the right ankle to assess for structural
damage or chondrocalcinosis
C. Perform arthrocentesis of the right ankle, with analysis of the synovial
fluid
D. Treat with ibuprofen and have the patient return to clinic in 1 week if
his symptoms do not improve
Which of the following is the most appropriate step to take next in the treatment of this patient?
A. Check the serum uric acid level; if elevated, initiate therapy with
indomethacin and colchicine
B. Obtain a plain radiograph of the right ankle to assess for structural
damage or chondrocalcinosis
C. Perform arthrocentesis of the right ankle, with analysis of the synovial
fluid
D. Treat with ibuprofen and have the patient return to clinic in 1 week if
his symptoms do not improve