DQ Jonathon is a 56 year-old retired automobile mechanic who has not been to the doctor in approximately 6-7 years
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Discussion Part One (graded)
Jonathon is a 56 year-old retired automobile mechanic who has not been to the doctor in approximately 6-7 years. He presents to your office complaining that 3 weeks ago he was awoken with severe pain and inflammation in his knee, which has been consistent since that initial night. Upon physical examination of his knee, it appears swollen and erythematous with periarticular involvement. Upon physical examination and laboratory results you notice the following:
| Physical examination: |
| GEN: well nourished, obese male (310 pounds) |
| VS: BP 191/112 HR 75 RR 15 T 98.6, HT 5’8” |
| EXT: Knee joint inflammation |
| Laboratory (fasting): |
| Na 139 mEq/L |
| K 3.8 mEq/L |
| Ca 9.1 mg/dL |
| CL 102 mmol/L |
| HCO3 22 mEq/L |
| BUN 10 mg/dL |
| SCr 0.9 mg/dL |
| Serum Uric Acid 6.5 mg/dL |
| Alb 4.1 g/dL |
| Cholesterol 300 mg/dL |
| UA: pH 6.8, uric acid 250 mg/24h |
What problems can be identified in this patient? Please provide a list of differential diagnoses, as well as indication of your primary diagnosis.
What is your pharmacological plan for your primary diagnosis including the medication, dose, and mechanism of action?
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