General Internal Medicine Question 39

A 48-year-old man is evaluated for a 2-day history of right anterior knee pain and swelling. The pain began suddenly and has increased in intensity. He currently rates his pain as an 8 on a 10-point scale. He has no knee instability and reports no fever or chills. He has no history of trauma and has never had this problem before. Other than his right knee pain and swelling, he feels well. He is employed as a carpet layer. His only medication is ibuprofen, which provides minimal relief. On physical examination, vital signs are normal. BMI is 28. On examination of the right knee, there is a palpable fluid collection that is located anterior to the patella. The right knee has full range of motion. There is no medial or lateral joint line tenderness or laxity with varus or valgus forces. Anterior drawer, posterior drawer, and Lachman tests are all negative. Which of the following is the most appropriate next step in management?

A Aspiration

B Compression

C Glucocorticoid injection

D Right knee radiographs

E Ultrasound

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