2-1 PATIENT NOTE: HIP PAIN HISTORY: Describe the history you just obtained from this patient.

Include only information (pertinent positives and negatives) relevant to this patients problem(s). HPI: 29 YO MALE C/O RIGHT HIP PAIN. INTENSITY 8/10, SHARP, STARTED ONE MONTH AGO, LASTS ALL DAY AND IS GETTING WORSE. RADIATES DOWN THE RIGHT LEG, CONSTANT, AGGRAVATED BY WALKING, BENDING OR STANDING. ALLEVIATED BY SITTING AND NAPROXEN. DENIES FEVER, CHEST PAIN, BOWEL OR BLADDER CHANGES. ROS: NEGATIVE EXCEPT AS NOTED ABOVE ALLERGIES: NONE MEDICATIONS: ALEVE FOR HIP PAIN PMH: NO PRIOR EPISODES PSH: NONE FH: FATHER DIAGNOSED WITH DIABETES MELLITUS, MOTHER DIED OF BREAST CANCER. SH: SMOKES 1PPD FOR 20YEARS, DRINKS EVERY DAY, CAGE 0/4, DENIES DRUG USE, WORKS AS A LAWYER, MARRIED FOR 3YEARS LIVES WITH WIFE AND THREE CHILDREN. SEXUALLY ACTIVE WITH WIFE ONLY PHYSICAL EXAM: Describe any positive and negative findings relevant to this patients problem(s). Be careful to include only those parts of examination you performed in this encounter. HE IS NO ACUTE DISTRESS. HIS VITALS ARE WITHIN NORMAL LIMITS. HIS BREATH SOUNDS ARE CLEAR BILATERALLY. HIS HEART SOUNDS ARE NORMAL WITHOUT RUBS, MURMURS, GALLOPS. HIS RIGHT HIP IS TENDER ON EXAMINATION, WITH DECREASED STRENGTH 3/5 ON THE RIGHT AND NORMAL STRENGTH ON LEFT SIDE 5/5. HIS RANGE OF MOTION ON THE RIGHT IS DECREASED WITH DECREASED FLEXION, EXTENSION AND STRAIGHT LEG RAISE TEST. THE LEFT HIP HAS NORMAL RANGE OF MOTION. HIS REFLEXES ARE INTACT AND SYMMETRIC, SENSATIONS INTACT BILATERALLY AND PULSES ARE NORMAL BOTH IN UPPER AND LOWER EXTREMITIES BILATERALLY. DATA INTERPRETATION: Based on what you have learned from the history and physical examination, list up to 3 diagnoses that might explain this patients complaint(s). List your diagnoses from most to least likely. For some cases. Fewer than 3 diagnoses will be appropriate. Then, enter the positive or negative findings from the history and physical examination (if present) that support each diagnosis. Lastly, list initial diagnostic studies (if any) you would order for each listed diagnosis (e.g. restricted physical exam maneuvers, laboratory tests, imaging, ECG, etc. Diagnosis #1: DISLOCATED FEMORAL HEAD HISTORY FINDING(S) PHYSICAL EXAM FINDING(S) - H/o trauma to right hip 2 weeks ago while - Right hip is tender playing soccer - Pain is 8/10 in intensity, sharp and radiating - Strength is 3/5 right hip

down the right leg -Aggravated by walking, alleviated by rest

- Range of motion decreased on the right side

Diagnosis #2: TRAUMA TO FEMORAL HEAD HISTORY FINDING(S) PHYSICAL EXAM FINDING(S) - H/o trauma to right hip 2 weeks ago while - Right hip is tender playing soccer - Aggravated by walking and activity, alleviated - Strength is 3/5 right hip by rest -Pain is sharp, 8/10 intensity, radiating down the - Range of motion decreased right leg on the right side Diagnosis #3: AVASCULAR NECROSIS OF FEMORAL EPIPHYSIS HISTORY FINDING(S) PHYSICAL EXAM FINDING(S) - Pain in the right hip for 1 month, getting - Right hip is tender worse. - Trauma to right hip while playing soccer - Strength is 3/5 right hip - Pain with movement and relieved on resting - Decreased range of motion on right side Diagnostic Studies: - CBC/UA - CT OF RIGHT FEMORAL HEAD - MRI OF RIGHT HIP JOINT - BLOOD CULTURE - URETHRAL CULTURES