Sehrish W.almost 5 years ago

Case analysis A 48-year-old man comes to your office complaining of severe right knee pain for8 hours. He states that the pain, which started abruptly at 2 a. m, waking him from sleep, is quite severe , so painful that even the weight of the bedsheets on his knee was unbearable . By the morning, the knee had become warm, swollen, and tender. He explains that he prefers to keep his knee bent and extending his leg to straighten the knee causes the pain to worsen. He has never had pain, surgery, or injury to his knees. A year ago , he did have some pain and swelling at the base of his great toe on the left foot , which was not as severe as this episode , and resolved in 2 or 3 days after taking ibuprofen. His only prior medical history is hypertension, which is controlled with hydrohlorothiazide. He works as a financial analyst, he is married, does not smoke, but does drink one or two drinks after work one to two times a week. On examination, his temperature is 100. 6F, his heart rate is 104 bpm, and his blood pressure is 136 / 78 mmHg. His head and neck examination is unremarkable, his chest is clear, and his heart is tachycardic but regular, with no gallops or murmurs. His right knee is swollen, with a moderate effusion and appears erythematous, warm , and very tender to palpation . He is unable to fully extend the knee because of pain. He has no other joint swelling pain , or deformity , and no skin rashes. What is the most likely diagnosis? 1. chief complaint: 2. what are signs of inflammation the patient have? What is your next step ? What is the best initial treatment ?