Bedside Diagnostic Challenge – 44-year-old woman with leg and ankle pain

Paul Griner, MD, MACPBedside Diagnostic Challenge, Internal Medicine, Medical News

Bedside Diagnostic Skills Challenge on chest pain

Today’s Bedside Diagnostic Challenge question comes from the desk of Med-Challenger Internal Medicine Editor-in-Chief, Paul F. Griner, MD, MACP.

Test your bedside diagnostic skills with this review question.


A 44-year-old woman presents with the complaint of pain in her lower legs and ankles for the past two months. Her past medical history and review of systems is benign and she is taking no medications except aspirin for the leg pain. She has a 25 pack-year history of smoking and she drinks one glass of wine each evening with dinner.

In the examining room, the patient sits with her legs up on the cushion of a chair. She says that elevating her legs reduces the pain. Physical examination reveals a healthy appearing woman with a Temperature of 98˚ F, Blood Pressure of 112/70 mm Hg, Pulse of 76/min and regular, and respirations of 16/min. Examination of her legs reveals marked tenderness and warmth along the anterior surface of the tibia, bilaterally, with 1+ tender, non-pitting edema of the ankles. The remainder of the physical examination is normal.

Laboratory studies:
Complete blood count-normal
Basic metabolic panel-normal
Sedimentation rate-40mm/hr

Normal Laboratory Values


Based on the diagnostic value of careful examination …

What diagnostic test would most likely explain this patient’s symptoms and signs?

Answer Options:

Rheumatoid factor assay

Alkaline phosphatase

Serum uric acid level

Chest X-ray

Answer Explanation & References:

Get the Full Review:

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About Bedside Diagnostic Challenge:

Except for Hospitalists, Emergency Medicine physicians, and Interventional Cardiologists, most internists will spend the bulk of their professional time with patients in an office setting.

Here is where finely tuned clinical skills are most important in leading to accurate diagnoses, fewer complications resulting from unnecessary tests and procedures, and lower costs. Med Challenger Bedside Diagnostic Challenge reinforces the value of these clinical skills and tests users on their knowledge of them.

Bedside Diagnostic Challenge questions are issued periodically every month as a free content benefit of Med-Challenger.

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About the Author:

Paul Griner MD, MACP graduated from the University of Rochester School of Medicine and completed his residency at the Massachusetts General Hospital, Boston, MA. He returned to Rochester as Chief Resident in Medicine and Hematology Fellow and remained in their Department of Medicine, rising to Professor. He served as a Senior Lecturer at Harvard Medical School and consultant at the Massachusetts General Hospital where he introduced a mentoring program for the faculty of General Internal Medicine.

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