Rosanna is a 32-year-old African American women who is is referred from the emergency department to follow-up at a primary care physician's office. She recently relocated to the area, and during the move, she slipped and fell, injuring her left ankle. Rosanna complains of severe pain in her left ankle that impairs her gait and caused her absence from work for 2 days. She had undergone an open reduction and internal fixation 6 months earlier secondary to a trimaleolar fracture. X-ray films did not reveal any new injury or osseous abnormalities other than the internal fixation device.
Her past medical history revealed no medical problems, and her medications before the recent fall included ibuprofen and oral contraceptives. Rosanna is not a smoker, she drinks fewer than two standard servings of alcohol per week (ie, one standard serving is 14 g of ethanol, the equivalent to 12 ounces of beer, 5 ounces of wine, or 1.5 ounces of distilled spirits at 80 proof), and she does not use or abuse any illegal drugs. The physician evaluates Rosanna and gives her a prescription for a refill of ibuprofen, 600 mg, to be taken three times a day. She has a follow-up visit scheduled for 4 weeks later.