Discussion Part One (graded)

Mrs. R. is a 66-year-old
Caucasian female who presents to the clinic with pain in her left hip that
worsens with walking, bending, standing, and squatting. When asked to describe
where the pain occurs, she places her fingers around the anterolateral hip region.
She denies any back pain, or pain in the posterior hip or along the lateral
thigh. Denies any previous injury, stumbling, tripping or falling. She states
that the pain has been getting gradually worse and is almost constant if she
walks or stands for a long period of time. She denies back pain, numbness,
tingling, or weakness in the extremities. She reports taking Ibuprofen 800 mg
approximately 3 times/week whenever she has significant hip pain. She is
concerned that she doesn’t know what is causing the pain and that she is having
to take increased doses of ibuprofen to manage the pain. She reports a current
pain level of 8/10 on the pain scale.

Background Information

She walks approximately
1 mile a day. She recently retired as an office manager 4 years ago.

PMH

Unremarkable

Immunizations

All vaccines are current

Screenings

Never had a colonoscopy

Last mammogram was 5
years ago

Social History

Has an occasional glass
of wine with dinner

Does not smoke

Surgical history

Cholecystectomy 20 years
ago

Hysterectomy 10 years
ago

Current Medications

Ibuprofen 200-800 mg prn
for hip pain

Discussion Questions
Part One

• What risk
  factors does this patient have that might contribute to her hip pain?
• What ROS
  would you conduct on this patient?
• What is
  your primary diagnosis? What evidence-based resource and patient data
  supports this diagnosis?
• What two
  differential diagnoses are appropriate in this patient’s case? What
  evidence-based resource and patient data supports these two differential
  diagnoses?
• What
  screening would you choose to best evaluate this patient’s chief
  complaint?