https://pixabay.com/photos/older-male-man-lake-look-bodensee-2865098/
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