PBL Sessions: Musculoskeletal Organ System

Page 4

History of Present Illness:

You see the patient 3 months later. He indicates that two days ago he had an episode of marked pain involving his big toe on the left. Your examination reveals a swollen joint that is still markedly tender and slightly warm and red. You perform a joint aspirate and obtain 2 mL of cloudy, slightly viscous and slightly yellowish fluid.

Further family history: He has a 25-year-old son who is an Air Force pilot. He has a 23-year-old daughter who is in London, England studying art, he thinks. His wife has been deceased for the past 3 years. She suffered a sudden stroke. Since that time he has taken up playing snooker with his friends several times a week.

Figure 4: Microscopic appearance of the joint fluid

Tasks

• What do these findings indicate?

• What hypotheses explain these findings?

• Explain your reasoning for the hypotheses you choose.

• How would you treat this acute condition?

• What learning issues are being identified?

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