Patient Presentation

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Chief Complaint:

Pain in the left ankle and right wrist; It hurts to walk and bear weight on the left foot, and this patient has trouble typing and writing.

Baxter Guthrie is a 62 year old white male. He presented to the ED with throbbing pain in his left ankle and right wrist. He has had the pain for almost 2 weeks, and states that it keeps getting worse. His wrist is especially swollen and hot to the touch. He ignored the pain since he is a boating mechanic and often works with his hands and experiences similar pains, which are usually relieved by ice and ibuprofen. However, he never has pain in his ankles or feet, so he thought this was pretty unusual. He states that he had to take a day off of work due to the pain, and he hasn’t taken a day off in almost two years.

Past medical history:

Cellulitis (2016)

Type 2 diabetes (2014)

Former smoker (20 pack years- quit in 2000)

Stage 2 renal disease (2017)

Family History:

Mother: type 2 diabetes, heart failure, hypertension

Father: smoker, stage 3 renal disease, arthritis

Brother: hypertension, type 2 diabetes, stage 2 renal disease

Sister: smoker, hypertension, anxiety

Social history:

Has worked as a boating mechanic for 42 years

Often enjoys shellfish with friends and coworkers at the local marina

Occasionally drinks whiskey

Allergies:

NKA

Medications:

Ibuprofen 400mg PRN

Physical assessment:

99.5 fever

6/10 pain when resting, 10/10 when bearing weight or working with hands

Skin:

Erythema on left ankle and right wrist

Hot to the touch

Swollen

Labs:

Uric acid 11.2

Creatinine:230 umol/L

BUN: 25mg/dL

WBC: 16,000

XRAY: no remarkable abnormalities