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. Provide evidence to support diagnostic tests that would be appropriate for your case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.
CASE STUDY #3
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 take into consideration, 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?)
*** rubric for guideline with grading is attached as well as episodic/focus note template that is to be used for discussion
Expert Solution Preview
Introduction:
The 15-year-old male patient is experiencing dull pain in both knees with occasional clicking of one or both knees and a catching sensation under the patella. As a medical professor, I would use the episodic/focused note template provided to assess the patient’s condition and provide evidence for appropriate diagnostic tests. Additionally, I would list five different possible conditions for the patient’s differential diagnosis and explain why I selected each.
Episodic/Focused Note:
Subjective: The patient is a 15-year-old male reporting dull pain in both knees, clicking in one or both knees, and catching sensation under the patella. The pain is constant and gets worse with activity. The patient is a frequent skateboarder and recently increased the frequency of skating practice.
Objective:
Vital signs: normal
Physical examination: Inspection reveals mild swelling and tenderness over both patellae with no redness, warmth, or deformities. Palpation shows no crepitus or bony irregularities. Range of motion is within normal limits, with no effusion or instability noted. Positive patellar grind test and patellar apprehension test.
Assessment:
Based on the patient’s symptoms and physical examination, the following differential diagnoses are possible:
1. Patellofemoral Syndrome – due to increased physical activity.
2. Osteochondritis dissecans – due to the catching sensation under the patella and clicking noise.
3. Knee sprain – due to constant pain and swelling over both patellae.
4. Chondromalacia patella – due to positive patellar grind test.
5. Meniscal tear – due to positive patellar apprehension test.
Diagnostic tests:
1. X-ray – to rule out bony abnormalities or fractures.
2. MRI – to assess for soft tissue injuries such as ligament tears, tendon injuries, and cartilage damage.
3. CT scan – to assess for bone injuries and to obtain a 3D image of the knee.
4. Arthroscopy – a minimally invasive procedure used to diagnose and treat various knee conditions.
5. Ultrasound – to identify soft-tissue injuries in the knee.
Conclusion:
In conclusion, the patient’s symptoms and physical examination suggest possible knee conditions such as Patellofemoral Syndrome, Osteochondritis dissecans, Knee sprain, Chondromalacia patella, and Meniscal tear. To confirm the diagnosis, appropriate diagnostic tests such as X-ray, MRI, CT scan, arthroscopy, and ultrasound may be needed. Further evaluation and management of the patient’s condition should be in consultation with an orthopedic specialist.
