Case 3: Knee Pain A 15-year-old male reports dull pain in both knees. Sometimes one or both knees click, and the patient describes a catching sensation under the patella. In determining the causes of the knee pain, what additional history do you need? What categories can you use to differentiate knee pain? What are your specific differential diagnoses for knee pain? What physical examination will you perform? What anatomic structures are you assessing as part of the physical examination? What special maneuvers will you perform?

With regard to the case study you were assigned:

• Review this week’s Learning Resources, and consider the insights they provide about the case study.
• Consider what history would be necessary to collect from the patient in the case study you were assigned.
• Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis?
• Identify at least five possible conditions that may be considered in a differential diagnosis for the patient.

Post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in the Week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis, and justify why you selected each.

Expert Answer

Episodic/Focused SOAP Note for Case #1 Back pain

Patient Information:

Initials, Age, Sex, Race

John Doe is a 42-year-old white male.

S.

CC “Pain in the lower back for the past month.”

HPI: John Doe is a 42-year-old white male who came to the clinic complaining of lower back pain for the past month. He notes that sometimes the pain radiates to his left leg. The pain started after sitting for 16 hours balancing his company’s budget five weeks ago. The pain often become sudden and make his legs weak. He has not taken any medication to alleviate the pain. He says that the severity of the pain can be scaled in a scale of 7/10.

Current Medications: No medications.

Allergies: No allergies.

PMHx: His pneumonia, influenza, and tetanus vaccines are up to date. The patient has no major medical condition.
Soc Hx: He married with three kids and likes listening to music and watching movies at his free time. He has been smoking two packets of cigarettes for the past 15 years. He denies alcohol use.

Fam Hx: His mother died aged 73 with type two diabetes. His father is alive but has heart problems. His other two younger siblings are healthy. His children are also healthy with no major conditions.

ROS:

GENERAL:  No chill, fever, fatigue, or weight loss.

HEENT:  Eyes:  No visual issues. Ears, Nose, Throat:  No hearing problems, sneezing, runny nose, or sore throat.

CARDIOVASCULAR:  No edema, chest pain, or palpitations.

RESPIRATORY:  No sputum, breathing problems, or cough.

GASTROINTESTINAL:  Reports pain in the lower back.

NEUROLOGICAL:  Reports occasional numbness or tingling of the leg extremities.

MUSCULOSKELETAL:  Reports pain in the lower back muscles

O.

Physical exam:

Constitutional: General Appearance: Healthy appearing adult male with moderate distress. Answers questions properly and is oriented and alert. Vitals: BP 136/90; P 88; R 20; T 36.3; W 92kgs; H 156cm.

HEENT: Head: Hair evenly distributed and head id normal cephalic. Eyes:  Extraocular movements intact, conjunctivae pink. Ears: Hearing intact, clear tympanic membranes on otoscopic. Nose: Clear mucus. Mouth: All teeth are present and in good shape. Throat: Tonsils are not swollen and have no lesions.

Heart: Regular rhythm and rate. No rubs or murmurs. Neck arteries have normal pulse.

Lungs: Chest walls are symmetric. Lungs are bilateral and clear to auscultation. Respiration easy and regular.

Abdomen: Positive straight leg test, no back tenderness, intact bilateral hip motion, unremarkable sensation and strength, negative crossed straight leg test. lumber spine is symmetrical.

Diagnostic results: The condition can be diagnosed using X-ray. Ball, Dains, Flynn, Solomon & Stewart (2019) note that X-ray can show the bone spur that may be pressing the nerve.

X-ray-Pending

A.

Differential Diagnoses

Sciatica: