Return to Scenario ListShow Learning Points most relevant to Phase 1:

Knee pain

Clinical Discipline(s)/Organ System(s)
Infectious Diseases, Musculoskeletal System, Orthopaedics, Rheumatology
Progress Test Topic(s)
A 70 year old Māori woman with a 1 year history of worsening knee pain underwent a left total knee joint replacement 6 weeks ago. She is a local kaumātua, helping to run a training programme for Māori youth, and usually plays bowls twice a week. She now presents with 5 days of increasing pain and swelling in this knee. She had a rigor and when she measured her temperature last night it was 38.8°C. Her left knee is markedly swollen, hot to touch and she cannot walk because of the pain.
Progress Test-Type Questions:   Question 1 | Question 2
Applied Science for Medicine 
   - Anatomy of the knee joint
   - Physiology of bone turnover and articular cartilage
   - Pathophysiology of osteoarthritis
   - Microbiology of septic arthritis and pharmacology of appropriate antimicrobials
Clinical and Communication Skills 
   - History from a patient with a swollen joint
   - Examination of the knee joint
   - Indications for joint aspiration and joint washout
   - Recognise sinister symptoms that could indicate bone malignancy
   - Management of osteoarthritis
   - Criteria for referral for joint replacement and common complications
   - Outline the management of septic arthritis including discussion with operating team
Personal and Professional Skills 
   - Consideration of risk and benefit with regard to joint replacement
   - Consideration of health literacy needs of the patient and family/whānau
Hauora Māori 
   - Respecting the mana and dignity of kaumātua, particularly within a medical context
   - Traditional ideas and beliefs that may exist amongst Māori elders
   - Consulting with whānau
   - Lower rates of joint replacement surgery with increasing deprivation
Population Health 
   - Growing burden of osteoarthritis care in an ageing population
   - Resource constraints and the effect on waiting lists for joint replacement
Conditions to be considered relating to this scenario
osteoarthritis, reactive or inflammatory arthritis, crystal arthropathy, Baker's popliteal cyst, meniscal tear
Less common but 'important not to miss'
septic arthritis, post-operative deep vein thrombosis (DVT), infection of joint prostheses
multiple myeloma, pathological fracture