Sunday, December 3, 2023
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Assistant Professor
Thurston Arthritis Research Center
University of North Carolina at Chapel Hill
This activity is intended for primary care physicians, orthopedists and orthopedic surgeons, rheumatologists, nurses, and pharmacists.
The goal of this activity is to increase awareness on the assessment, diagnosis, and management of patients who present with joint pain.
Upon completion of this activity, participants will:
As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.
Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.
Assistant Professor
Thurston Arthritis Research Center
University of North Carolina at Chapel Hill
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CME / ABIM MOC / CE Released: 9/24/2018
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The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short post-test assessment based on the material presented.
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Leslie is a 55-year-old woman who has come to her primary care physician because of progressive pain in her left knee. She describes it as a dull aching pain that worsens with activity. She says the pain is typically worse at the end of the day compared with how it feels in the morning. When she sits for a long time or goes for a long car ride, her knee "stiffens up" and it takes her a few minutes to loosen up when she starts to move again.
Leslie reports that the pain has begun to limit her activities. She previously worked out 3 times a week at the gym, but she now finds workouts too painful. Although she can stand throughout the day at her cashier job, she has recently found that when she comes home from work in the evening, she just wants to sit in front of the television. She props her leg up on the coffee table and sometimes finds that the elevation reduces her pain. Leslie says that sometimes she notices mild swelling in her left knee; but on questioning, she denies any redness or warmth. For the swelling she uses an ice pack.
| History | Findings |
|---|---|
| Medical | Leslie's last annual examination was 4 months ago. At that time her HbA1c was 6.1%. |
| Medications | None |
| Allergies | NKDA |
| Surgical | None |
| Family | Mother: alive, age 80 Father: alive, age 82 No siblings |
| Social | Married Alcohol: social (1-3 glasses of red wine/wk) Tobacco: none Illicit drugs: none |
| Physical Examination | Findings |
| Vital signs | BP 110/78 mm Hg; pulse rate 87/min, regular; respirations 12/min; temperature 98.7⁰F; O2 saturation 95%; BMI 28 kg/m2 |
| General | Well-appearing woman in no acute distress |
| Skin | No rash or breakdown |
| HEENT | Normal conjunctiva and oral mucosa, good dentition |
| Pulmonary | Normal |
| Heart | Normal |
| Abdomen | Normal, positive bowel sounds, no organomegaly |
| Musculoskeletal |
|
| Neurological | AAOx3; pleasant affect |
AAOx3 = awake, alert, oriented to self, location, and time; BMI = body mass index; BP = blood pressure; HbA1c = glycated hemoglobin; HEENT = head, eyes, ears, neck, throat; NKDA = no known drug allergies.
