Incident-to Quiz
A 51-year-old female patient returns for a follow-up visit for osteoarthritis of the right knee with the physician assistant (PA). She had an intraarticular corticosteroid injection of her right knee six weeks ago. She reports significant improvement in her knee pain and stiffness; she states the stiffness has been reduced to five to 10 minutes after long car rides, and she only has morning stiffness one or two times a week. She also reports queasiness since starting etodolac, which was prescribed to relieve pain. The PA changes the medication to tramadol 50 mg every six hours, as needed.
The patient has normal vital signs, height 5’10”, weight 190 pounds with a body mass index of 28.5, and temperature is 97º. Her lungs are clear. The heart has a regular rate and rhythm with no murmurs, frictions, or rubs. She has no masses or tenderness in her abdomen. Her right knee has crepitus and mild tenderness on extreme flexion, but no warmth or effusion. Her left knee is unremarkable with full range of motion and no tenderness.
Diagnosis: 1. Osteoarthritis right knee; 2. Mucositis due to medication.
Plan: The patient is given a prescription for tramadol 50 mg. She is counseled on the benefits of daily exercise and weight loss in the management of her osteoarthritis and given suggestions on how to incorporate daily physical activity into her schedule, along with recommendations to reduce fat and calorie intake. She is asked to return in three months for a follow-up appointment, sooner if any problems arise.
