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.
Complete blood count-normal
Basic metabolic panel-normal
Based on the diagnostic value of careful examination …
What diagnostic test would most likely explain this patient’s symptoms and signs?
Rheumatoid factor assay
Serum uric acid level
Answer Explanation & References:
Get the Full Review:
This case was sampled from Med-Challenger IM, the #1 online internal medicine review. Stay up to date with Med-Challenger, the most current clinical knowledge review & MOC efficiency products available.
See our Current Special Offers.
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.
Subscribe to the Med-Challenger blog for more Diagnostic Challenge blogs and other free clinical content from Med-Challenger.
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.
Share this Post