Scribd Logo
Upload

Welcome to Scribd!

  • CBCR Joint Pain Student Version

    Uploaded by

    Nika Gianashvili
    61 views4 pages
    1. A 45-year-old woman presented with 3 months of left knee and ankle pain. Her history revealed gradual onset of pain after increased time spent on her feet at work. 2. Based on her history, osteoarthritis was considered most likely, while rheumatoid arthritis and gout were less likely. Examination of the knee was needed to evaluate these possibilities. 3. Diagnostic tests confirmed osteoarthritis in the knee with bone spurs seen on x-ray. Treatment with over-the-counter anti-inflammatories and exercises was prescribed, with the prognosis of continued but manageable symptoms if treated.

    Original Description:

    Original Title

    Cbcr Joint Pain Student Version

    Copyright

    © © All Rights Reserved

    Available Formats

    DOCX, PDF, TXT or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document
    1. A 45-year-old woman presented with 3 months of left knee and ankle pain. Her history revealed gradual onset of pain after increased time spent on her feet at work. 2. Based on her history, osteoarthritis was considered most likely, while rheumatoid arthritis and gout were less likely. Examination of the knee was needed to evaluate these possibilities. 3. Diagnostic tests confirmed osteoarthritis in the knee with bone spurs seen on x-ray. Treatment with over-the-counter anti-inflammatories and exercises was prescribed, with the prognosis of continued but manageable symptoms if treated.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    61 views4 pages

    CBCR Joint Pain Student Version

    Uploaded by

    Nika Gianashvili
    1. A 45-year-old woman presented with 3 months of left knee and ankle pain. Her history revealed gradual onset of pain after increased time spent on her feet at work. 2. Based on her history, osteoarthritis was considered most likely, while rheumatoid arthritis and gout were less likely. Examination of the knee was needed to evaluate these possibilities. 3. Diagnostic tests confirmed osteoarthritis in the knee with bone spurs seen on x-ray. Treatment with over-the-counter anti-inflammatories and exercises was prescribed, with the prognosis of continued but manageable symptoms if treated.

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 4

    Tbilisi State University, Faculty of Medicine

    Course: Case Based Clinical Reasoning

    Case: A 45-year old woman with joint pain


    Student version

    Introduction
    Joint pain is a common complaint among older people and is a major cause of disability. Despite
    that it does not represent a clear diagnostic entity, joint pain is a major public health issue in its
    own right. Low back pain (mostly men) and neck pain (mostly women), as well as knee and hip pain
    are most commonly mentioned. Identifying modifiable risk factors for joint pain in patients of older
    age (e.g. weight, lack of physical exercise, metabolic disorders) should therefore be given a high
    priority. As the most common rheumatologic disease, osteoarthritis represents the great majority
    of joint pain cases, and many studies use the latter as outcome when investigating the relation
    between potential risk factors and joint problems. However, joint pain is not synonymous with
    osteoarthritis and its risk factors may differ from those identified for osteoarthritis.

    Objectives
    After discussing this case, students will have gained skills for a proper diagnostic approach to
    patients with joint pain. They will know the possible causes of joint pain and understand the
    different characteristics in history taking and physical examination of different diagnoses. They can
    carry out appropriate examination, investigation and management for a patient with joint pain.

    Detailed objectives
    After preparation, students should have knowledge of:
    a) Joint and peri-articular tissue anatomy and pathology;
    b) Diseases and clinical syndromes where joint pain is the prevailing symptom - Osteoarthritis,
    Rheumatoid Arthritis, Ankylosing Spondilytis, Gout, Diabetic arthropathy, Reactive Arthritis,
    Vasculitis, Infectious Arthritis, Acute Rheumatic Fever, Familial Mediterranean Fever.

    Preparation
    Questions the students should prepare in advance of the class:
    1. What are the main characteristics of joint pain?
    2. Pattern recognition in arthritis
    3. General evaluation of adult patients with arthritis
    4. Laboratory tests and instrumental investigations used in patients with joint pain
    5. What are the most common cases of knee pain in adult patients?

    References for students:


    1. Internal Medicine Textbooks:
    a) Harrison's Principles of Internal Medicine – Part: Disorders of Joints and Adjacent Tissues,
    or
    b) Cecil – Essentials of Medicine / Goldman's Cecil Medicine – Section: Musculoskeletal and
    Connective Tissue Disease, or
    c) Lange - Current Medical Diagnosis and Treatment – Section: Rheumatologic and Immunologic
    Disorders, or
    d) Davidson’s Principles and Practice of Medicine – Section: Muskuloskeletal Disease

    2. Rheumatologic books:
    a) Kelley's Textbook of Rheumatology – Sections/Chapters: Structure and Function of Joints;
    General Evaluation of the Patient; Diagnostic Tests and Procedures in Rheumatic Diseases;
    Rheumatoid Arthritis; Vasculitic Syndromes; Crystal Associated Synovitis; Osteoarthritis;
    Rheumatic Fever; Systemic Lupus Erythematosus and related syndromes), or
    b) Primary Care Rheumatology (Klippel, Dieppe, Ferri) – Sections/Chapters: Principles of Diagnosis
    1
    and Management; Regional Pain and Monoarticular Disorders; Polyarticular Disorders; Systemic
    Lupus Erythematosus; Acute Rheumatic Fever; Older People
    3. Websites:
    a) http://www.nmihi.com/i/arthralgia.htm

    References for Peer Teachers (in addition to the above mentioned)


    1. http://www.medscape.com/viewarticle/705219
    2. http://www.medscape.com/viewarticle/774928

    Suggested non-medical reading:


    Jorge Luis Borges – “The Garden of Forking Paths” ("El Jardín de senderos que se bifurcan")

    Assessment
    Students:
    0 points absence or presence without relevant participation
    1 point normal active participation

    Peer teachers:
    0 points poor preparation, insufficient leadership of the session
    1 point sufficient preparation, moderate leadership of the session
    2 points good preparation, good leadership of the session

    Estimated time schedule


    Case 2 hrs (with 15 min break)
    Lecture - 7 min
    Q.1 – 7 min
    Q. 2 – 7 min
    Q. 3 – 7 min
    Q.4 – 15 min
    Q.5 – 10 min
    Q.6 – 15 min
    Q.7 – 10 min
    Q.8 – 10 min
    Q.9 – 10 min
    Q.10 – 10 min
    Q.11 – 5 min
    Q.12 – 7 min

    Stage I - Presentation of patient's problem


    Case

    You are a GP. At your office, a 45-year old woman, former kindergarten teacher and now agent of a
    beauty products selling company, presents with complaints of prolonged, mild to moderate pain in her
    left knee for the last three months. Sometimes the pain is present in the left ankle too, often coinciding
    with exacerbation of knee pain.
    You haven’t seen the patient before, as she recently moved to your district.

    Question 1. What is the main problem of this patient?

    Question 2. What is the most likely cause of the joint pain for this patient?
    2
    Group your hypothesis in three categories (I -Likely, II-Less Likely, III – Not very Likely, but
    not excluded)

    Question 3. Which questions must be asked to discriminate between the most relevant
    hypotheses?

    Stage II - Results of history taking

    Hand-out 1 (shown on the screen and read out loud)

    Question 4 . What is the most likely diagnosis now?

    Question 5. Which parts of physical examination are required in order to exclude some
    unlikely, but important hypotheses? Which physical examinations are necessary to confirm
    the most likely hypothesis and discriminate between others?

    Question 6. Is there any diseases in the table you would now exclude from the list? Or
    maybe the information provided makes you thinking to add some new diagnosis to the
    table?

    Question 7. Which hypotheses now remain in the differential diagnosis to be further


    investigated?

    Question 8. Which diagnostic investigations need to be done, to confirm or exclude the


    remaining diagnoses?

    Stage IV - Results of diagnostic investigations

    Hand-out 3 (shown on the screen and read out loud)

    Question 9. Interpret the findings from the diagnostic tests. How much certainty do they
    give about the hypotheses?

    Question 10. Which diagnosis prevails now?

    Question 11. Given this diagnosis and patient circumstances, which therapy or policy for
    care is now indicated? What is the prognosis if the patient is treated? What if the patient
    would not be treated?

    Stage V – Results of therapeutic management

    Hand-out 4 (shown on the screen and read out loud)

    Question 12. One of the students from the group summarizes the whole case
    3
    chronologically in a few minutes.

    You might also like