American Board of Internal Medicine (ABIM) Certification Practice Exam

What procedure should all patients with prepatellar bursitis undergo?

1. X-ray imaging of the knee

2. Bursal fluid aspiration

3. Arthroscopy

4. Physical therapy evaluation

The correct answer is: Bursal fluid aspiration

Patients with prepatellar bursitis should undergo bursal fluid aspiration because this procedure not only helps confirm the diagnosis by allowing for analysis of the bursal fluid but also provides immediate relief from symptoms. The aspiration can help identify any potential infectious processes by analyzing the fluid for white blood cell count, presence of bacteria, or crystals, which could indicate gout or pseudogout. Additionally, removing the fluid can alleviate pressure and discomfort, enhancing the patient's mobility and decreasing pain. This procedure should be done before considering other treatments and interventions, making it a critical step in the management of prepatellar bursitis. While X-ray imaging may be utilized to rule out bony abnormalities or other associated injuries, it is not routinely necessary for diagnosing bursitis itself. Arthroscopy is more invasive and typically reserved for cases where there is suspicion of intra-articular pathology or when conservative measures fail. Physical therapy evaluation can be beneficial for rehabilitation but is not a primary intervention for the acute management of bursitis.