3-9 PATIENT NOTE: KNEE PAIN HISTORY: Describe the history you just obtained from this patient.

Include only information (pertinent positives and negatives) relevant to this patients problem(s). 28 YO M C/O RIGHT KNEE PAIN STARTED 3 DAYS AGO. 8/10 INTENSITY, THROBBING, AND GETTING WORSE. STIFF IN THE AM, WITH CONSTANT PAIN. NON RADIATING, AGGRAVATED BY WALKING OR BENDING. ALLEVIATED WITH MORTRIN. +ERYTHEMA, INFLAMMATION AND WARM TO TOUCH. DENIES NUMBENESS, TINGLING OR OTHER JOINT PAIN. NO BOWEL OR BLADDER CHANGES. DENIES INFECTIONS, FEVER, OR CHEST PAIN. ROS: NEGATIVE EXCEPT AS NOTED ABOVE ALLERGIES: NKDA MEDICATIONS: MOTRIN PMH: DIAGNOSED WITH ASTHMA 10 YRS AGO, NO PREVIOUS EPISODES OF JOINT PAIN. STD 10 YEARS AGO, TREATED WITH ANTIBIOTIC AND RESOLVED PSH: NONE FH: PARENTS ALIVE AND WELL SH: DENIES TOBACCO, ETOH OR DRUG USE. LIVES ALONE. WORKS IN A RESTAURANT, SEXUALLY ACTIVE WITH MORE THAN 5 PEOPLE IN THE LAST YEAR, DOES NOT USE CONDOMS. PHYSICAL EXAM: Describe any positive and negative findings relevant to this patients problem(s). Be careful to include only those parts of examination you performed in this encounter THE PATIENT IS IN NO ACUTE DISTRESS AND VITALS WITHIN NORMAL LIMITS. HIS HEAD, NOSE AND THROAT APPEARS NORMAL AND ATRAUMATIC. HIS BREATH SOUNDS ARE CLEAR TO AUSCULTATION BILATERALLY. HIS HEART SOUNDS ARE NORMAL WITH S1/S2. HIS ABDOMEN IS SOFT AND NON TENDER AND BOWEL SOUNDS PRESENT. HIS RIGHT KNEE IS SWOLLEN AND TENDER WITH ERYTHEMA AND RESTRICTED RANGE OF MOTION ON FLEXION AND EXTENSION OF THE RIGHT KNEE COMPARED TO THE LEFT KNEE. LEFT KNEE SENSATION TO DULL AND SHARP ARE INTACT WITH NORMAL INTACT REFLEXES. THE STRENGTH IS 5/5 AND THE ME MURRAY TEST, ANTERIOR AND POSTERIR DRAWER SIGN ARE NEGATIVE. THE PULSES ARE NORMAL WITH 2/4 BILATERALLY. DATA INTERPRETATION: Based on what you have learned from the history and physical examination, list up to 3 diagnoses that might explain this patients complaint(s). List your diagnoses from most to least likely. For some cases. Fewer than 3 diagnoses will be appropriate. Then, enter the positive or negative findings from the history and physical examination (if present) that support each diagnosis. Lastly, list initial diagnostic studies (if any) you would order for each listed diagnosis (e.g. restricted physical exam maneuvers, laboratory tests, imaging, ECG, etc.

Diagnosis #1: Gout HISTORY FINDING(S) PHYSICAL EXAM FINDING(S) - RIGHT KNEE PAIN FOR 3 DAYS - ERYTHEMA IS PRESENT -THROBBING AND GETTING WORSE -RIGHT KNEE IS SWOLLEN, TENDER -INFLAMMATION AND WARM TO -RESTRICTED RANGE OF MOTION OF TOUCH RIGHT KNEE Diagnosis #2: Pseudogout HISTORY FINDING(S) PHYSICAL EXAM FINDING(S) -RIGHT KNEE PAIN FOR 3 DAYS -ERYTHEMA IS PRESENT -THROBBING AND GETTING WORSE -RIGHT KNEE SWOLLEN, TENDER -INFLAMMATION AND WARM TO -RESTRICTED RANGE OF MOTION OF TOUCH RIGHT KNEE Diagnosis #3: Gonococcal arthritis HISTORY FINDING(S) PHYSICAL EXAM FINDING(S) -SEXUALLY ACTIVE WITH MULTIPLE - ERYTHEMA IS PRESENT PARTNERS AND DOES NOT PRACTICE -RIGHT KNEE SWOLLEN, TENDER SAFE SEX -RESTRICTED RANGE OF MOTION OF -RIGHT KNEE PAIN FOR 3 DAYS RIGHT KNEE -INFLAMMATION AND WARM TO TOUCH Diagnostic studies: -XRAY OF RIGHT KNEE -JOINT ASPIRATION FOR GRAM STAIN -CBC/UA -RECTAL EXAM -CULTURE OF URETHRAL DISCHARGE