Respond to at least two of your colleagues on 2 different days who were assigned different case studies than you. Analyze the possible conditions from your colleagues’ differential diagnoses. Determine which of the conditions you would reject and why. Identify the most likely condition, and justify your reasoning.
Patient Initials: __TC_____ Age: ___15____ Gender: ___Male____
SUBJECTIVE DATA:
Chief Complaint (CC): Bilateral Knee Pain
History of Present Illness (HPI): TC is a 15-year-old African-American male high school student who is in 9th grade. He presents to the clinic today with complaints of dull bilateral knee pain. Pateint states that he’s experencing a catching sensation under my kneecaps.” The patient states that this has been going on for weeks now. He said that his knees really bother him the most when playing basketball, but they still bother him even when he’s walking. He says the pain comes and goes and he rates the pain level as a 5 on a pain scale of 1-10 after taking 200mg of Ibuprofen. His last dose he stated was taken orally 45 minutes ago. He then stated that the pain without pain medicine is was 10/10 before. The patient states that resting and icing his knees helps to alleviate the pain also.
Medications:
Ibuprofen 200mg PO Q6-8hrs PRN pain
Multi-vitamin PO Daily
Allergies:
Sulfa drugs – Facial Swelling
Past Medical History (PMH):
No Past Medical Hx
Past Surgical History (PSH):
No Past Surgical Hx
Personal/Social History:
Patient is in high school. He enjoys playing basketball, football, and baseball. He lives at home with his parents and younger brother and sister.
Immunization History:
His immunizations are up to date.
Significant Family History:
P Grandmother- Diabetes
P Grandfather- HTN
M Grandmother- Diabetes, Heart Disease
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M Grandfather- HTN, Hyperlipidemia
Review of Systems:
General: Denies weakness, no recent weight loss/gain, fever, and fatigue.
HEENT: The patient has no headache and no history of head injury. He denies blurred vision, double vision, and visual loss. no hearing loss. No sneezing, runny nose, and congestion. Patient denies a sore throat.
Respiratory: denies a cough and shortness of breath.
CV: Patient denies chest pain, and chest discomfort. Patient exhibits no palpitations or edema.
GI: Denies change in dietary patterns or bowel habits. He denies abdominal pain, nausea, and vomiting or diarrhea., stomach distress or blood in the stool
GU: Patient denies painful urination, frequency, and urgency
MS: Patient has bilateral knee pain for , Patient denies any other joint, muscle, or back pain. Denies any recent injury.
Psych: Patient denies depression or anxiety
Neuro: Patient denies headaches, syncope, dizziness, and has no numbness, or tingling in any extremities. Patient has no change in bowel or bladder control.
Integument/Heme/Lymph: Patient denies rash or itching. Skin warm and moist
Endocrine: Patient denies cold or heat intolerance. No polyuria or polydipsia.
Allergic/Immunologic: Sulfa Drug
OBJECTIVE DATA
Physical Exam:
Vital Signs: Blood Pressure 112/70; Pulse 85; Temp. 98.7; Resp. 18; Weight 170lbs: Ht. 510
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General: Healthy looking young male, who appears slightly uncomfortable.
HEENT: PERRLA, EOMI, oronasopharynx is clear
Neck: Carotids no bruit, jvd or tmegally
Chest/Lungs: CTA AP&L
Heart/Peripheral Vascular: RRR without murmur, rub or gallop; pulses+2 bilat pedal and +2 radial
ABD: benign, nabs x 4, no organomegaly; mild suprapubic tenderness diffuse no rebound
Musculoskeletal: Reduced range of motion with a facial grimace. Knees free from swelling and crepitus, and tibiofemoral joint space smooth and firm. No acute fractures noted. Clicking in the knee noted on exam.
Neuro: CN II XII grossly intact, DTRs intact
Skin/Lymph Nodes: No edema, clubbing, or cyanosis; no palpable nodes
ASSESSMENT:
Diagnostics:
Computerized tomography (CT) scan, Bilateral Knee X-ray, CBC, and Magnetic resonance imaging (MRI).
Differential Diagnosis (DDx):
1. Osgood-Schlatter Disease: A common cause of knee pain in growing adolescents. It is an inflammation of the area just underneath the knee where the ligament from the patellar tendon attaches to the tibia. It is most often happening during growth spurts, when bones, muscles, tendons, and other structures are rapidly changing. Because physical activity puts additional stress on bones and muscles, for example, children who partake in athletics especially running and jumping are at an increased risk for this condition. However, less active adolescents might as well experience this issue. (American Academy of Orthopedic Surgeons, 2018).
2. Patellar tendonitis: Patients with overuse of the legs has a probable comorbidity (Rebella, 2015).
3. Patellar instability: Knee catching or clicking with movement, pain, excessive patellar movement (Mahmoud, 2016).
4. Left Osteochondritis Dissecans: Pain, left knee (Jones & Williams, 2016).
5. Left Medial Meniscus Tear: Clicking in the knee noted on exam, pain (Dains, Baumann, & Scheibel, 2016).
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References
American Academy of Orthopedic Surgeons. (2018). Osgood-Schlatter Disease (Knee Pain). Retrieved from https://orthoinfo.aaos.org/en/diseases–conditions/osgood-schlatterdisease-knee-pain.
Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.
Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessment and clinical diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier Mosby.
Jones, M. H., & Williams, A. M. (2016). Osteochondritis dissecans of the knee. The Bone and Joint Journal. doi:10.1302/0301-620X.98B6.36816
Mahmoud, T. (2016). Evaluation of combined arthroscopic lateral release and medial patellofemoral ligament reconstruction for the treatment of recurrent lateral patellar instability. The Egyptian Orthopaedic Journal, 51(2), 117. doi:10.4103/1110- 1148.203144
Rebella, G. (2015). A prospective study of injury patterns in collegiate pole vaulters. The American Journal of Sports Medicine, 43(4), 808-815. doi:10.1177/0363546514564542
