Que -
A 40 y.o male presented with 1 week history of jaundice without pruritus, palpable tender hepatomegaly and knee pain. What is the likely diagnose?
Ans -
1 - Hepatitis B
2 - Hepatitis C
3 - Gall stone
4 - Cholecystitis
5 - Hepatocellular carcinoma
A 40 y.o male presented with 1 week history of jaundice without pruritus, palpable tender hepatomegaly and knee pain. What is the likely diagnose?
Ans -
1 - Hepatitis B
2 - Hepatitis C
3 - Gall stone
4 - Cholecystitis
5 - Hepatocellular carcinoma
hmmm.....hep B would probably be best fit but question somewhat strange. why specifically knee pain?, are you implying a concomitant septic arthritis process or is it just viral arthralgia with subjective symptom of knee pain?
ReplyDeleteHi John,
ReplyDeleteNothing is perfect or 100% in medicine, but Common thing is common and uncommon thing is uncommon in medicine. There is no option regarding septic arthritis.
Knee pain is to suggest hepatitis B (viral arthralgia, common in Hep B) and to differentiate from other cause of jaundice given in the question.
If question will say generalised arthralgia (which most of the patient don't complain) that makes answer too easy, because most of the textbook will use this word.
good one, thanks for the tips on everyday practice. since i'm not yet practising its good to know. but suppose the pt. does complain of bad knee pain, wouldnt it be right to rule out septic arthritis? given hep B can occur in IV drug abusers, as is staph.aureus infectn common in IV drug abusers as well, and also that septic arthritis can destroy a joint rapidly if not treated early.
ReplyDeleteI would definitely check temperature and do knee examination and consider CRP and aspiration if any concern. I would also keep septic arthritis in my mind even if with multiple joints.
ReplyDeleteI recently had patient (IVDU) with fever, knee and left shoulder pain, swelling and swelling of all hand joints and found to have septic arthritis of knee and shoulder with reactive arthritis in hands. Interesting, isn't it?
In general remember, fever, single joint pain and swelling - septic arthtitis, until proven otherwise.
thanx Sachin Bro...
ReplyDelete