Patient Profile: Nemat Awad is a 60 year old married housewife lives in Maan, she was admitted to the hospital via outpatient department on August 7th 2016 at 12:30 am, history was taken by Raya Jadaan a 5th year medical student on Aug 9th 2016 at 10:30 am from the patient herself. Chief Complain: She was admitted for left TKR surgery. History of Present Illness:
The patient was admitted to the
hospital after being appointed for a TKR surgery on 2016 2 years ago from now. She was suffering from severe bilateral anteromedial knee pain of two years duration that worsened over time; worse on the left one. The pain is dull in nature, continous, exacerbated by exertion, relieved by laying down and not moving, it radiates to lower back and to foot, associated with numbness and tingling. She doesnt recall having any trauma. The pain has significantly impaired her life as she cant perform the minimal activities without an escort, her motion is limited, she cant get out of bed or stand up from a chair by her
own, it is hard for her to get dressed
by her own and would be impossible. The patient visited a private rheumatology clinic before coming to JUH, she was given 3 steroid injections to each knee that partially relieved her. There is no associated fever, chills, anorexia or night sweats, neither did she complain of weight loss or fatigue or loss of appetite. The pain is worse in winter. The patient lives in her sons house with his wife and chidren in an independent house on ground floor and she had never worked outdoor or performed any abnormally exhausting activities or even did household chores. Her KFT is normal . Her older sister had a TKR at about her same age.
Past Medical History:
Hypertenson 10 years of duration Past Surgical History: Hemorrhoidectomy 10 years ago Lumbar disc prolapse Allergy: No known drug allegy Drugs : Hydrochlorthiazide 160/12.5 she is compliant. Social History: The patient lives wither sons family she has five children 2 males and three females all living in Maan. She
is ensured in JUH , she doesnt smoke,
drink alcohol or takes hooka.
Family history: Her sister had TKR surgery, 2 hypertensive brothers, a diabetic and hypertensive sister. Review of systems: Free other the hypertension that was mentioned above. Physical examination:
The patient was sitting upright
conscious, oriented, alert to time place and person, she was not connected to ventilators or IV lines. On inspection there is no erythema, bruising or discoloration of the knee. The musculature of both legs is symmetrical and normal, no signs of atrophy. On palpation the knee is tender, not worm. The patient cant flex her leg more than 15 degrees, she cant extend them, there is crepitus, locked knees, positive effusion. No popping, No giving away. Not all tests could be performed due to the extreme pain the patient was in.