Jonathon is a 56 year-old retired automobile mechanic who
has not been to the doctor in approximately 6-7 years. He presents to your
office complaining that 3 weeks ago he was awoken with severe pain and
inflammation in his knee, which has been consistent since that initial night.
Upon physical examination of his knee, it appears swollen and erythematous with
periarticular involvement. Upon physical examination and laboratory results you
notice the following:

Physical examination:

GEN: well nourished, obese male (310 pounds)

VS: BP 191/112 HR 75 RR 15 T 98.6, HT 5’8”

EXT: Knee joint inflammation

Laboratory (fasting):

Na 139 mEq/L

K 3.8 mEq/L

Ca 9.1 mg/dL

CL 102 mmol/L

HCO3 22 mEq/L

BUN 10 mg/dL

SCr 0.9 mg/dL

Serum Uric Acid 6.5 mg/dL

Alb 4.1 g/dL

Cholesterol 300 mg/dL

UA: pH 6.8, uric acid 250 mg/24h

What problems can be identified in this patient? Please
provide a list of differential diagnoses, as well as indication of your primary
diagnosis.What is your pharmacological plan for your primary diagnosis
including the medication, dose, and mechanism of action?

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