Review Question - QID 212799

A 67-year-old man comes to the clinic complaining of left shin pain for the past 2 months. He reports that ever since he injured that leg from a fall he has been experiencing this 8/10, stabbing pain at his left upper shin that comes and goes. It has been progressively worsening to the point that it is affecting his daily life (e.g., walking to the grocery store). The patient denies fever, chills, weight loss, chest pain, shortness of breath, weakness, or loss of sensation. A physical examination demonstrates what appears to be a soft tissue mass at the proximal tibia. A radiograph of the left leg is shown in Figure A. Which of the following is a significant risk factor for this patient’s disease?