i-Human Case Study – Week 5 | NRNP 6531 Comprehensive SOAP
Note: Acute Monoarticular Arthritis (Gout) Tod Gouseau – 57-Year-
Old Male Presenting With Right Knee Pain.
,Comprehensive SOAP Note – Acute Monoarticular Arthritis
(Gout)
Patient: Tod Gouseau
Age: 57
Date: [Insert date]
Course: NRNP 6531 – Week 5
Preceptor: [Insert preceptor name]
S: Subjective
Chief Complaint (CC):
“My right knee is swollen and really painful.”
, HPI (History of Present Illness):
Mr. Tod Gouseau is a 57-year-old obese Caucasian male who presents with a sudden onset of
right knee pain, redness, swelling, and decreased range of motion. He reports that the pain began
overnight and has progressively worsened. He rates the pain as 8/10, sharp and throbbing. He
denies trauma. He mentions previous similar episodes in his left big toe several months ago. He
admits to heavy alcohol consumption over the weekend and indulging in red meat. No fever or
chills.
Associated Symptoms:
• Swelling, warmth, erythema in the right knee
• Difficulty walking
• No systemic symptoms (no fever, chills)
Past Medical History (PMH):
• Hypertension
• Hyperlipidemia
• Obesity (BMI >30)
Past Surgical History:
• Appendectomy at age 25
Medications:
• Lisinopril 20 mg daily
• Atorvastatin 40 mg nightly
• Occasional NSAIDs for joint pain
Allergies:
• NKDA
Family History:
• Father: History of gout and HTN
• Mother: Type 2 diabetes
• No family history of rheumatoid arthritis or autoimmune disease
Social History:
• Alcohol: Drinks beer 4–5 times per week, heavy over the weekend
• Smoking: Quit 10 years ago (20-pack-year history)
• Diet: High intake of red meats and processed foods
• Occupation: Truck driver (sedentary lifestyle)
Note: Acute Monoarticular Arthritis (Gout) Tod Gouseau – 57-Year-
Old Male Presenting With Right Knee Pain.
,Comprehensive SOAP Note – Acute Monoarticular Arthritis
(Gout)
Patient: Tod Gouseau
Age: 57
Date: [Insert date]
Course: NRNP 6531 – Week 5
Preceptor: [Insert preceptor name]
S: Subjective
Chief Complaint (CC):
“My right knee is swollen and really painful.”
, HPI (History of Present Illness):
Mr. Tod Gouseau is a 57-year-old obese Caucasian male who presents with a sudden onset of
right knee pain, redness, swelling, and decreased range of motion. He reports that the pain began
overnight and has progressively worsened. He rates the pain as 8/10, sharp and throbbing. He
denies trauma. He mentions previous similar episodes in his left big toe several months ago. He
admits to heavy alcohol consumption over the weekend and indulging in red meat. No fever or
chills.
Associated Symptoms:
• Swelling, warmth, erythema in the right knee
• Difficulty walking
• No systemic symptoms (no fever, chills)
Past Medical History (PMH):
• Hypertension
• Hyperlipidemia
• Obesity (BMI >30)
Past Surgical History:
• Appendectomy at age 25
Medications:
• Lisinopril 20 mg daily
• Atorvastatin 40 mg nightly
• Occasional NSAIDs for joint pain
Allergies:
• NKDA
Family History:
• Father: History of gout and HTN
• Mother: Type 2 diabetes
• No family history of rheumatoid arthritis or autoimmune disease
Social History:
• Alcohol: Drinks beer 4–5 times per week, heavy over the weekend
• Smoking: Quit 10 years ago (20-pack-year history)
• Diet: High intake of red meats and processed foods
• Occupation: Truck driver (sedentary lifestyle)
