lOMoARcPSD|16995810
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Wk 9 gout flare
Primary Care of Adults Across the Lifespan (Walden University)
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, lOMoARcPSD|16995810
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Le昀琀 knee pain, swelling, redness x 2 days
HPI: Mr. Tod Gouseau is a 57yo Caucasian M presen琀椀ng with acute le昀琀 knee pain. He reports gradual
onset of mild aching discomfort, redness, and swelling to le昀琀 knee 2 days ago. The pain is constant and
has worsened to a 6-8 out of 10 throbbing super昀椀cial and deep pain. He denies radicular pain. He denies
acute injury or trauma to a昀昀ected knee. Pain is exacerbated by weight bearing, bending, and walking.
Pain is improved with rest but is not eliminated. Addi琀椀onal home therapies include OTC ibuprofen
without relief. The pain makes walking and sleeping di昀케cult. He denies similar complaints with
addi琀椀onal joints, fever, chills, fa琀椀gue, paresthesia, weakness, joint s琀椀昀昀ness, myalgia. He reports
intermi琀琀ent episodes of le昀琀 great toe swelling and one previous episode of le昀琀 knee pain, swelling, and
redness approximately 1 year ago. He has a history of osteoarthri琀椀s and HTN. His HTN is stable and is
controlled by HCTZ 25mg po qday. He has a family history of rheumatoid arthri琀椀s. He denies a known
history of gout. He drinks 3 beers 2 to 3 nights per week, follows a Mediterranean diet, a琀琀empts to walk
30 mins every day.
ROS:
General: Nega琀椀ve for fa琀椀gue, fever, chills, addi琀椀onal joint involvement, generalized weakness or
s琀椀昀昀ness.
CV: Posi琀椀ve for localized swelling to Le昀琀 knee
Nega琀椀ve for CP, palpita琀椀ons, dizziness, syncope, orthopnea, exercise intolerance, cyanosis, claudica琀椀on,
peripheral edema
Resp: Posi琀椀ve for 25yr history of 0.5-1 PPD tobacco smoking, quit 15 yrs ago.
Nega琀椀ve for SOB, dyspnea, cough, wheezing, sputum produc琀椀on
GI: Denies N/V/D, cons琀椀pa琀椀on, abd pain, melena, hematochezia, hematemesis, dysphagia, dyspepsia,
incon琀椀nence, or jaundice
GU: Nega琀椀ve for dysuria, urgency, frequency, incon琀椀nence, or polyuria
MS: Posi琀椀ve for Le昀琀 knee pain, swelling, and redness. Posi琀椀ve for family hx of RA. Posi琀椀ve for impaired
gait.
Nega琀椀ve for addi琀椀onal joint involvement, myalgia, trauma, hx of gout, muscle cramping or s琀椀昀昀ness,
knee catching/popping/locking.
Neuro: Nega琀椀ve for paresthesia, numbness, dizziness, syncope, decreased sensa琀椀on, ver琀椀go, generalized
of unilateral weakness, tremors, or seizures.
PMH: HTN: controlled by HCTZ 25mg po qd, diet, and exercise
Osteoarthri琀椀s
PSH: Lap Cholecystectomy: 8 yrs ago, no complica琀椀ons
R shoulder arthroscopy for rotator cu昀昀 injury: 15yrs ago, no complica琀椀ons
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