Medical case studies and clinical analysis
This paper solves the following cases scenarios:
Case A: Mrs Patrick is a 52 year old female, complaining of aching pain in her knees. She also complains of stiffness in her knee joints, esp. on waking up in the morning since past 1 month. She has noticed the stiffness increases after sitting for longer periods without moving her legs. Both the knees are swollen and painful.
She mentioned that last winter, she had developed a sudden swelling and redness in her fingers. The joints were painful and she could not do any household work like washing or cleaning dishes then, as it increased the pain. She was given some painkillers to help with the pain. After this, the pain and swelling would come and go at irregular intervals through out the year. She also mentioned that after the first episode, her fingers have always been a little bit stiff.
Upon interrogating about her family history she said her mother died of disability due to rheumatoid arthritis. Her elder brother suffers from gout. Her father is still very healthy and energetic at the age of 95 years.
Physical appearance:
She is extremely overweight, short stature. She weighs 95kgs and is about 151cms tall. She walks with the help of a walking stick and has difficulty when climbing stairs.
Physical examination:
Both knee joints are swollen and there is restricted movement. The range of movement is restricted. Her fingers have painless stiff nodosities in the interphalangeal joints.
Crepitus can be felt in the left knee upon examination.
Vital signs:
Test Result Normal range
Blood pressure 130/90 mm of Hg (110/70 – 130/90) mm of Hg
Pulse rate 80, per minute 60-100 per minute
Respiratory rate 14 per minute 12-16 per minute
Temperature 36.9 ?C 36.6 – 37.2 ?C
Case : Mrs. Thomas is 35 years old physical trainer at "Health First Fitness center" since past 5 years. Recently she has been complaining of pain and numbness in her hand and fingers. She describes it as "pins and needles" with burning and tingling sensations. Mrs Thomas is a mother of two young girls and is pregnant with her third child. She mentioned that she suffered from similar pains during her first pregnancy, but the pain was alright after that. She is three months' pregnant and is on insulin for Gestational diabetes.
Her hands are slightly puffy in the morning. She gives a past history of falling from a swing at the age of 13 and she had to wear a collar for about 2 weeks. No neurological damage occurred because of the fall and she has had no neck or arm pain since then.
On examination:
Hands: slightly puffy
Joints: normal Range of Movement. Thenar eminence is wasted bilaterally
Sensory examination: touch sensation in the thumb, index and middle finger of both hands is altered.
Sustained wrist flexion, for about 1 minute reproduces her symptoms of numbness of the hands
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