Assignment Paper

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Week 7 Signature Assignment Scenario
Your patient presents at your clinic today with a chief complaint of left knee pain.
You have the following information:
63 year old Caucasian male, BMI 32, BP: 144/88, Pulse 80, O2 99% RA,
Allergies: NSAIDS (hx of ulcer)
PMH: obesity, hypothyroid, HTN, dyslipidemia, diabetes type II since 2004
PSH: right knee arthroscopy 2008, appendectomy 1990
Medications: Tylenol prn, levothyroxine, atorvastatin, lisinopril, metformin
SH: Smoker 1/4 ppd, occasional alcohol use, denies current drug use (hx unknown), no formal exercise
program.
Labs: Last A1C 10.0
Depression screen: negative
Upon interviewing, the patient reports a long history of chronic pain mostly in his knees. His left knee
seems to have recently worsened and now is 4/10 on the pain scale consistently. His pain seems to be
worse with any activity. It does not seem to radiate. He tried icing it and taking Tylenol with little relief and
admits taking Ibuprofen occasionally when he “can’t take it anymore”. He reports morning stiffness, but this
improves quickly once he gets moving. His worse symptom is pain.
Review of Systems: positive for bilateral hip pain
Physical exam: negative except for tenderness over left knee with mild swelling, and pain on ROM. No
evidence of instability in the joint.
Imaging: No reports available for review. Previous records however indicate “bilateral knee joint space
narrowing noted”.
1. Describe the pathophysiology of osteoarthritis with detail.
2. You suspect arthritis as a diagnosis with this patient. Does this patient appear to be consistent with a
diagnosis of osteoarthritis or rheumatoid (RA)? Justify your answer
3. Identify at least 1 nonmodifiable and 1 modifiable risk factor for osteoarthritis with a brief explanation as
to the significance for each.
4. You consider your plan for this patient given your assessment. Describe a topic of patient education
related to your plan of care for this patient.
5. Before you end your visit, the patient stops you and proceeds to describe symptoms he forgot to mention
earlier. He complains of pain in his feet when he walks. He also states he feels numbness and tingling in
his feet bilaterally to about mid shin/calf. He states it, “seems like the area of a sock”. You perform a quick
sensation exam and find decrease in sensation distally throughout the bilateral feet which improves as you
move proximally. The patient would like to know if this is related.
a. What is a potential diagnosis for this symptom? Justify your answer.
b. Is this Nociceptive or Neuropathic pain? Justify your answer.
c. Is this related to your original diagnosis earlier in the visit?