D: What brings you here today? 

P: I've had this like, pain in my knee. It started within the last few hours and my knee's swollen, it's painful. Um, I can barely move it.

D: Okay, were you uh, did you injure yourself at all before the last few hours or anything? Any trauma to um, is it the right knee or the left knee?

P: It's the left knee, an no, no trauma uh, or anything like that. I've never hurt this knee before in my life.

D: Okay, and has this ever happened to you before?

P: Uh. Um, no, nothing in my joints. I've had other infections before, like in my skin, um, like cellulitis, but I, I've never had a knee, knee problem like this before.

D: Okay, I see. And have you ever had cellulitis in that area?

P: Uh, I, I had it over, kind of my, uh, like over my foot before. 

D: Okay, and um, where would you describe the pain is? Is it like on the kneecap, is it above the kneecap, below? Where would you describe it?

P: I would say it's like my whole knee, it's like uh, I don't know, it looks like it's going to explode.

D: Okay, is it like um, so, it's swollen, is it red and warm?

P: It is, yeah, it's really red.

D: Okay 

P: And warm as well. 

D: Okay, and how would you describe the pain? Um, is it like a sharp, stabbing pain, or is it an aching pain?

P: It's a, a stabbing pain.

D: Okay, and uh, are you mainly having the pain with movement of your knee, or um, when you're pressing on it?

P: Uh, I would say both, I can't um, I can't really move it, it'll give me pain. And even pressing on it, it's, it's quite painful.

D: Okay. And on a scale of uh, 1 to 10, sorry 0 to 10, with 10 being the worst pain you've felt in your life, how much would you rate this pain?

P: Uh, it's a 9.

D: A 9, okay. Um, so it just started a few hours ago. Is there anything that makes the pain better or worse?

P: Um, I mean just trying to stay as still as possible is all I've been been doing so far, uh because, um, like any type of movement is really bad.

D: Okay, and are you able to weight bear, are you able to stand and walk by yourself?

P: Uh, I, I was pretty much like hopping on one leg to, to get in here and as soon as I could, I got in a wheelchair, just because it uh, hurts so bad. 

D: Okay, and um, do you have any pain or symptoms in any other joints or muscles of your body?

P: No, just, it's just my left knee.

D: Just your left knee, okay. Um, do you have any other symptoms like fevers, chills, nausea or vomiting?

P: Um, I have felt uh, uh feverish, yeah. But then, yeah, I, I felt feverish and um, but I haven't had any chills, though.

D: Okay, when were you feeling fevers?

P: Uh, just like, today, it's kind of, yeah, it started within the last day.

D: Okay, and um, did you get a chance to measure your temperature at all? If not, we can do that here. 

P: Um no, no, I didn't get to uh, I, I didn't check it.

D: Okay, and have you been sick at all recently, either with um, any cold-like symptoms uh, or any GI symptoms, like diarrhea, um, constipation, anything like that?

P: Uh, no, I haven't had any, anything like that.

D: Okay, and have you recently had any um, sexually transmitted diseases, or exposures to uh, ticks or lyme disease? 

P: Uh, I don't think so. I've been just, in well, in the city. I haven't traveled anywhere, and I uh, I haven't been sexually active for, for quite a while now, so. 

D: Okay, okay. Uh, have you recently, at all, had um, any procedures done on your knee, like any surgeries or any joint like um, injections or aspirations?

P: No, nothing done to my knee.

D: Okay. Okay, um, so yeah, we'll take a temperature of your uh, fever, and, so are you able to flex or extend your knee at all, or is it very painful?

P: It's really painful. I uh, the movement's really limited.

D: Okay, and has the pain been constant since it started a few hours ago.

P: Yeah, it's gotten uh, like it's, it's gotten slightly worse.

D: Okay, I see. Okay, um, any skin changes or rashes anywhere on your body?

P: No, it's just the red knee.

D: Okay. Um, any changes in your weight or appetite?

P: Uh no, no. I haven't had any changes there.

D: Okay, and otherwise, are you having um, any symptoms of uh, dizziness, fainting?

P: Uh, no, I haven't had any of those symptoms.

D: Okay, any weakness um, in your extremities?

P: No, no weakness.

D: Okay, um, do you have any past medical conditions that you've been diagnosed with? Any diabetes? High blood pressure?

P: Uh, I've been told my, my blood sugar has been like, it hasn't been controlled, so yeah, I think I have diabetes. Um, uh, but that's, that's it.

D: Okay, um, do you take anything for medicate, medication for your diabetes?

P: Uh, yeah, I, I take metformin and um, and uh, yeah, that, that's all I've been taking, but, I mean, it's really hard for me to uh, like get my medication sometimes and so um, I don't always take it. 

D: Okay, I see. Um, and do you have any allergies to any medications? 

P: Uh, not that I, not that I can think of. And, so something that I forgot to mention is uh, like I've had hepatitis in the past as well um, and uh, yeah. 

D: And do you know hepatitis you've had? 

P: Um, I've had, it was uh, hepatitis C and uh, I was, um, treated, I was treated for it. 

D: Okay. Okay, and how long ago was that?

P: That was about uh, two years ago.

D: Okay, and uh, did they tell you like how it may have been transmitted at all? Was it, uh, sexually? Um, was it through um, use of IV drug use? And did they tell you what the likely cause was?

P; Yeah, the, the likely cause was um, I was told it was through IV uh, drug use. I've been using now for uh, for about 10 years.

D: Okay, and have you um, and what do you usually use? 

P: Uh, well like, any, anything that I, that I can usually. But I, I guess like um, various types of opioids are kind of the, the, the main thing that I'll, that I'll use.

D: Okay, and have you um, injected uh, drugs recently at all?

P: Uh, yeah I, about uh, about two days ago was the last time.

D: Okay, okay. And um, do you use any other uh, drugs? Any recreational drugs like marijuana or any, do you inject any other drugs at all?

P: Yeah, I'll smoke, uh, smoke marijuana as well and um, like, I'll sometimes like, I'll take uh, pills too like dilaudid is um, is something that I'll, I'll get my hands on, but it can be expensive so, um, just, just whatever is available.

D: Okay. Um, have you had uh, when was the last time you had cellulitis?

P: Uh, he last time was about six months ago.

D: Okay, and were you admitted at all, or were you treated as an outpatient?

P: Uh, I was treated as an outpatient for that, and it did clear up. It wasn't the first time that I've, I've had cellulitis and, and um, yeah, so it was treated.

D: Okay, have you had any hospitalizations or surgeries in the past?

P: Um no, I haven't.

D: Okay. Uh, any family history of any conditions um, musculoskeletal or rheumatologic conditions? Uh, any rheumatoid arthritis, anything like that? 

P: Uh, I don't think so.

D: Okay. And currently, right now, um, what is your living situation like?

P: Uh, so um, I just live with uh, two of my, um, or actually sorry no, I live with my uh, with my parents and uh, yeah, so it's just both my parents.

D: Okay. And, um, do you currently work?

P: Uh, I was working until like, I um, yeah about uh, about 15 years ago and now I, like I got injured on the, uh, um at work and I've had like chronic back pain and I don't know, I think that's kind of how this partly all, all started. So I've been at home receiving uh, I'm on disability.

D: Okay. And do you smoke cigarettes?

P: Uh, I do, yeah I, I, I smoke um, about half a pack uh, to a pack a day.

D: Okay, and how long have you been smoking for?

P: Uh, so this has been, uh, about 20 years.

D: 20 years, okay. And do you drink alcohol? 

P: Um, sometimes yeah. I'll, I'll have uh, just a few beers, maybe a few beers a week. 

D: Okay, and yeah, we were just talking about some of uh, like the movement, but you're saying you have pain with any kind of movement at all, right?

P: Yeah, it, it's really painful, I just, I try not to move it at all. 

D: And it's very red and swollen and warm as well?

P: Yeah, all of those. 

D: Any symptoms at all in your hips or ankle?

P: No, those feel fine. I can move my hip and ankle okay, and no pain.

D: Okay, alright, so those are all the questions I had for you. We'll do like a full physical examination, take a look at your knee, um, and most likely, what this sounds like, is something called septic arthritis. It's uh, it's when there's like an infection that um, can go into your joints and uh, it is a pretty serious issue that we need to um, assess and treat as soon as possible. So the first thing that we will um, need to do, we'll need to do some blood work just to get some inflammation markers and just your uh, CBC, and see if you have um, an infection. However, we'll also need to do a joint aspiration of your of your um, go your knee, and we'll be taking some fluid within your joint called the synovial fluid and assess for um, we'll send in for um, culture, and look for like these crystals, and count. And then based on that, we'll understand um, the infection you have and what kind of infection you have. We will start you on antibiotics right away um, today, and so you will be um, here for a while until we get all those results back. And you may also require um, an admission today as well.

P: Okay, uh, thank you. Yeah, that, that sounds good.

D: Alright, yeah, so yeah, we'll get all that done for you shortly, and uh, we'll go from there. 

P: Right, thank you.

D: And um, we might also need an x-ray, so just sit tight. We'll, we'll come call you.

P: Okay, thank you.

D: Alright, you're welcome.