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

Get all the history questions, physical exam, and complete EHR documentation.
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

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