12-17-2008, 01:58 PM
A 68-year-old man is evaluated for left hip and knee pain. The pain has been present for a few weeks and is worsening. It occurs with activity and occasionally at night, waking him from sleep. In the past, similar pains responded to rest, heat, acetaminophen, and NSAIDs, but these are not effective for the current symptoms. His history includes a recent diagnosis of renal cell carcinoma for which he underwent left nephrectomy. He completed chemotherapy 4 months ago but has recently been depressed and less active. He also has hypertension controlled with hydrochlorothiazide.
On examination, BMI is 29.2. Temperature is 37.1 °C (98.8 °F), pulse rate is 102/min, and blood pressure is 136/74 mm Hg. He has no pain on palpation of the hip but has limited range of motion with external rotation, flexion, and abduction. Palpation and range of motion at the knee are normal.
Which of the following diagnostic tests is most approprate?
A Positron emission tomography
B CT“guided arthrocentesis
C Bone scan
D Synovial fluid analysis
On examination, BMI is 29.2. Temperature is 37.1 °C (98.8 °F), pulse rate is 102/min, and blood pressure is 136/74 mm Hg. He has no pain on palpation of the hip but has limited range of motion with external rotation, flexion, and abduction. Palpation and range of motion at the knee are normal.
Which of the following diagnostic tests is most approprate?
A Positron emission tomography
B CT“guided arthrocentesis
C Bone scan
D Synovial fluid analysis