Week 5: Douglas Bell/ Tod Gouseau/ Cyrus Horton/ Wade Dickson
57 y/o
5′ 10″ (178 cm)
197.0 lb (89.5 kg)
Reason for encounter
Acute left knee pain for 2 days
Location
Outpatient clinic with x-ray, ECG, and laboratory capabilities
History Questions
- How can I help you today?
- Do you have any other symptoms or concerns we should discuss?
- Have you been having fevers?
- Have you had any trauma to your knee(s)?
- When did the pain in your knee(s) start?
- Does the pain in your knees radiate someplace else? Where?
- Does the pain in your knee(s) come and go?
- ……
Physical Exams Required
- Assess gait and stance
- Blood pressure
- Inspect skin overall
- Palpate extremities
- Pulse
- Reflexes – deep tendon
- Respiration
- Temperature
- Test range of motion
- ……
Differential Diagnoses
- Arthritis
- Arthritis, septic
- Bursitis
- Calcium pyrophosphate dihydrate decomposition disease (CPPD/ pseudogout)
- …..
- ……
Diagnosis Feedback
The synovial fluid analysis is positive for monosodium urate (MSU) crystals. Clinical findings supportive of the diagnosis of acute monoarticular gout include the following:
- Physical findings: red, swollen, painful left knee, left first MTP tophus
- History of a previous occurrence
- Risk factors: thiazide-diuretic use, alcohol consumption, diet rich in purines
