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  1. #1
    Asclepius1's Avatar
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    A 55 yr old male with right knee pain, redness and swelling


    A 55 yr old male with right knee pain and swelling
    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
    Monoarticular rheumatoid arthritis
    Traumatic knee injury
    Reactive arthritis

  2. #2
    Asclepius1's Avatar
    Asclepius1 is offline Ultimate Member 537 points
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    SPís Checklist:
    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
    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
    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
    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.
    Inflammatory osteoarthritis
    Septic arthritis
    Pseudo gout
    Monoarticular rheumatoid arthritis
    CBC with differential, ESR
    Joint aspiration
    Knee X-ray
    ANA, Rheumatic Factor
    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.

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