PBL Sessions: Musculoskeletal Organ System

Page 2

History of Present Illness:

Your physical examination shows vital signs with T 36.3 C, P 80, R 14, and BP 145/90 mm Hg. The heart rate is regular with no murmurs. The lungs are clear to auscultation. Palpation of the abdomen reveals no masses or areas of tenderness, and active bowel sounds are present. You not the presence of a 4 cm long transverse well-healed scar in the right lower quadrant. The rectal examination reveals no masses, and the stool guaiac is negative. Pulses in the extremities are 4+ bilaterally. Motor strength is not decreased. Reflexes are normal. Inspection and palpation of joints of upper and lower extremities reveals no significant deformities, other than slight enlargement of the second and third metacarpophalangeal joints bilaterally. Range of motion is slightly decreased. There is no joint warmth or redness. There is a 2 cm area beneath the skin over the left olecranon process that is firm and mildly tender, and this raises the skin surface slightly. There is also enlargement, mostly lateral, of the first metatarsophalangeal joint on the left, and this is mildly tender to palpation. Cranial nerves II - XII are intact and there are no localizing neurologic signs. Funduscopic examination is unremarkable.

Tasks

• What additional problems can you identify?

• What hypotheses can you suggest that might be causing his problems?

• Explain your reasoning for the hypotheses you choose.

• What learning issues are being identified?

• What additional information might you request?

Stop !! Complete discussions and tasks before moving to the next page.