2/11/2026
This patient data was gathered by Roll no 23 Batch 2023 as part of his competence based learning evaluation portfolio preparation.
* Case-1
* Date: 02-11-2026
* Age/Gender: 50/Female
* Occupation: Farmer/Worker
Clinical Notes
* C/O (Chief Complaints):
* Left knee pain since 1 year, after trauma.
* Neck pain since 1 week.
* No H/O fever, headache, or chest pain.
* Difficulty in walking since 6 months.
* H/O Present Illness:
* Patient was normal 1 year ago.
* Developed knee pain in left knee after trauma.
* Onset: Acute/Sudden.
* Duration: 1 year.
* History of significant swelling on the left knee.
* Past History (P.H.):
* No H/O HTN, DM.
* No H/O TB.
* No H/O similar complaints before.
* Personal History (P.Hx):
* Diet: Mixed.
* Appetite: Adequate/Good.
* Micturition/Bowel: Regular.
* Sleep: Adequate.
* Smoking and Alcohol: No.
Here is the deidentified text version of the handwritten medical notes from the image:
* H/O: No significant family history.
* G.E.:
* P/S: CCTC
* Pulse: 78 bpm
* BP: 120/80 mmHg
* R.R.: 18 cpm
* Temp: Afebrile
* On Examination:
* Oedema = Absent
* Gait = mild gait
* Swelling = not present in left knee
* Palpation:
* Local rise in temperature
* Movements: painful flexion
* Cutaneous sensations: normal
* R.S.: Normal & breath sounds
* CNS: No focal neurological deficit
* Abdomen: Soft, non-tender
* Provisional Diagnosis: Traumatic injury to the left knee joint, with suspected soft tissue injury
History & Differential Diagnosis
* Chronology & Etiology: The patient developed acute left knee pain and significant swelling following trauma 1 year ago, which progressed to difficulty walking over the past 6 months. What structural injuries (such as meniscal tears, ligamentous instability, or post-traumatic osteoarthritis) fit this timeline, and why might a traumatic injury from a year ago lead to a delayed onset of gait disturbance at the 6-month mark?
* Connecting the Symptoms: She now presents with a 1-week history of neck pain alongside her chronic left knee pain. Could these two complaints be biomechanically linked—for instance, through an altered gait and compensatory posture—or do we need to evaluate them as two entirely separate clinical entities?
* Occupational Context: Knowing that she is a 50-year-old farmer/worker, how do her daily physical demands (such as heavy lifting, carrying loads on her head or shoulders, prolonged squatting, and walking on uneven terrain) influence both her differential diagnosis and the functional impact of her symptoms?
* Systemic & Red Flag Screening: She has no history of fever, headache, chest pain, tuberculosis, diabetes, or hypertension. Which high-risk infectious, inflammatory, or referred-pain conditions do these pertinent negatives help rule out, and what additional red-flag questions (such as radiculopathy, bowel/bladder changes, or night pain) should still be asked?
Physical Examination & Clinical Reasoning
* Targeted Knee Exam: Given the history of trauma and significant swelling, which specific physical examination maneuvers would you prioritize to differentiate between intra-articular derangement (e.g., ACL/meniscal pathology) and degenerative joint changes?
* Cervical Spine & Neurological Assessment: To evaluate her acute neck pain, how would you structure a focused cervical spine and upper-limb neurological exam to distinguish mechanical muscle strain from cervical spondylosis or nerve root compression?
* Gait Analysis: Because she has had difficulty walking for 6 months, what specific gait abnormalities (e.g., antalgic gait, Trendelenburg sign, or flexed-knee gait) would you look for as she walks into the clinic, and how might those compensations stress her axial skeleton?
Investigations & Management
* Diagnostic Workup: If you could only order initial baseline imaging in a rural or resource-limited setting, what specific radiographic views of the knee and cervical spine would yield the most diagnostic value, and why?
* Holistic Management Plan: Considering her occupation as a farmer, what challenges might she face in adhering to standard conservative advice like "rest and avoid heavy lifting," and how can we design a realistic, patient-centered rehabilitation and pain management plan?
Would you like to focus on a specific competency area next—such as formulating a structured physical exam checklist or discussing a step-by-step management plan for this case?
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