Sponsored Links
Results 1 to 2 of 2
  1. #1
    Asclepius1's Avatar
    Asclepius1 is offline Ultimate Member 537 points
    Join Date
    Feb 2006
    Posts
    5,087
    Downloads
    0
    Uploads
    0
    Thanks
    0
    Thanked 0 Times in 0 Posts

    A 55 yr old male with right knee pain, redness and swelling

    Advertisements



    A 55 yr old male with right knee pain and swelling
    Vitals:
    PR: 95/min
    BP: 135/85 mmHg
    RR: 22/min
    Temp: 100.5

    Mental Checklist of DD:
    Inflammatory osteoarthritis
    Septic arthritis
    Lyme disease
    Pseudo gout
    Gout
    Monoarticular rheumatoid arthritis
    Traumatic knee injury
    Reactive arthritis

  2. #2
    Asclepius1's Avatar
    Asclepius1 is offline Ultimate Member 537 points
    Join Date
    Feb 2006
    Posts
    5,087
    Downloads
    0
    Uploads
    0
    Thanks
    0
    Thanked 0 Times in 0 Posts
    SPís Checklist:
    History:
    Asked about the onset of pain
    Asked about progression
    Asked about the severity of pain
    Asked about intensity of pain
    Asked about location
    Asked about quality
    Asked about radiation
    Asked about associated symptoms like fever, nausea, vomiting
    Asked about history of travel ( For Lyme disease endemic areas)
    Asked about any history of tick bites
    Asked about any rash anywhere in the body
    Asked about any pain and swelling in the other joints
    Asked about any recent history of febrile illness
    Past History:
    Asked about similar episodes in the past or joint problems
    Asked about previous hospitalizations
    Asked about past medical problems (Inflammatory bowel disease, Gout, Pseudogout, Rheumatoid arthritis or
    Osteoarthritis)
    Asked about family health
    Asked about appetite and weight changes
    Asked about any medications I am using
    Asked about illicit drug use
    Asked about smoking
    Asked about alcohol intake
    Asked about sexual practices
    Asked about bowel and bladder habits
    Asked about occupation
    Examination:
    Informed me
    Washed hands
    Draped appropriately
    Checked my knee for full range of motion
    Checked my knee for an effusion by ballottement or bulge method
    Checked all other joints for selling and redness
    Auscultated lungs and heart
    Counseling:
    Explained physical findings and possible diagnosis
    Explained further work up (CBC, ESR, Joint aspiration)
    Offered on going support
    Communication Skills:
    Knocked before entering the room
    Introduced himself and greeted warmly
    Used my name to address me
    Paid attention to what I said and maintained good eye contact
    Asked few open ended questions
    Asked non leading questions
    Asked one question at a time
    Listened to what ever I said with out interrupting me in between
    Used lay manís language
    Used appropriate transition sentences
    Used appropriate draping techniques
    Summarized the history and explained physical findings
    Expressed empathy, made appropriate reassurances
    Asked whether I have any concerns/ questions.
    DD:
    Inflammatory osteoarthritis
    Septic arthritis
    Pseudo gout
    Monoarticular rheumatoid arthritis
    Gout
    Investigation:
    CBC with differential, ESR
    Urinalysis
    Joint aspiration
    Knee X-ray
    ANA, Rheumatic Factor
    Additional:
    MRI of joint for history of trauma
    Lyme titers for H/O tick bite and travel to Lyme endemic areas (New England etc)
    Important points:
    You may get a case of trauma to knee also. In such scenario please ask the following questions and do the following tests
    along with the above check list.
    Ask what was he (patient) doing at the time the pain began.
    Ask are there any noises heard at the time of injury (Popping sound indicates anterior cruciate ligament injury)
    Ask whether the knee was buckling or unstable.
    Ask about locking and unlocking of joint ( For meniscal injury)
    Perform Lachman's maneuver or Drawers test for cruciate ligament injury.
    Perform McMurray's maneuver.
    In the counseling explain that he needs immediate orthopedics consultation for possible meniscal or ligamental injury.

Similar Threads

  1. looking for: 3.5mm Mini-Stereo Male to Two RCA Male Speaker Cable
    By auc13 in forum AUC Medical School Classifieds
    Replies: 0
    Last Post: 12-02-2009, 07:54 AM
  2. Case #2: 32-year-old black woman with pain and swelling
    By Asclepius1 in forum USMLE Step 3 CCS Forum
    Replies: 0
    Last Post: 11-25-2004, 05:21 PM
  3. any Knee pain Q, find it here/ Helps alot
    By Anonymous in forum USMLE STEP 3 Forum
    Replies: 0
    Last Post: 04-21-2004, 12:46 PM
  4. MANGAGENT OF MONOARTICULAR SWELLING
    By Anonymous in forum USMLE STEP 3 Forum
    Replies: 0
    Last Post: 06-01-2003, 11:27 AM
  5. Case# 3: 25y/o male with a complaint of lower abdominal pain
    By Hanson in forum USMLE STEP 2 CS Forum
    Replies: 4
    Last Post: 04-09-2003, 05:44 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •