1. Step 6
1.1. Review session 1
1.1.1. Summary of step 5
1.1.1.1. anatomy and function of synovial joints
1.1.1.2. difference between gout, arthritis and SLE (presentations)
1.1.1.3. diagnosis and clinical presentation of rheumatoid arthritis
1.1.1.3.1. genetic aspects (familial?)
1.1.1.4. mechanisms of chronic arthritis
1.1.1.5. what kind of arthritis does present with these symptoms
1.2. Report new knowledge
2. Step 7
2.1. Inquiry plan and info gathering
2.1.1. History of presenting complain
2.1.1.1. age?
2.1.1.1.1. 45
2.1.1.2. what joints are involved?
2.1.1.2.1. both hands, both knees
2.1.1.3. morning stiffness
2.1.1.3.1. more than one hour
2.1.1.3.2. last 6 weeks
2.1.1.4. associated symptoms
2.1.1.4.1. her eyes are ok
2.1.1.4.2. good weight
2.1.1.4.3. no skin changes
2.1.1.4.4. no fever
2.1.1.4.5. no chest pain
2.1.1.5. what relieves the symptoms?
2.1.1.5.1. not associated with movement
2.1.1.6. what's the impact of the desiese
2.1.1.6.1. problems with daily activities
2.1.1.7. how severe is the pain
2.1.1.7.1. 8/10
2.1.1.7.2. pain is progressive
2.1.1.8. no painkillers
2.1.2. Previous medical / surgical history
2.1.2.1. no significant past medical history
2.1.2.2. appendicitis
2.1.3. Drug history / allergy
2.1.3.1. allergic to penicillin
2.1.3.2. allergic to nuts
2.1.4. Family history
2.1.4.1. mother was complaining of joint pain before she passed out
2.1.4.2. her mother is diabetic
2.1.4.3. her father has hypertension
2.1.5. Social / occupational history
2.1.5.1. she have children
2.1.5.2. recently started smoking
2.1.5.2.1. 2 months ago
2.1.5.3. recently started drinking alcohol
2.1.5.3.1. every night
2.1.5.4. she's menopause
2.1.6. Physical examination
2.1.6.1. vital signs
2.1.6.1.1. stable
2.1.6.2. average weight
2.1.6.3. she looks ill
2.1.6.4. fine cervical spines
2.1.6.5. decreased range of motions
2.1.6.6. spleenomegaly
2.1.6.7. pale eye
2.1.6.8. hands
2.1.6.8.1. ip
2.1.6.8.2. reduced range on motions in the radiocarpal joing
2.1.6.8.3. no muscle atrophy
2.1.6.9. knees
2.1.6.9.1. maybe there is effusion
2.1.6.9.2. swelling
2.1.7. tests results
2.1.7.1. hematology
2.1.7.1.1. elevated
3. Step 8
3.1. Diagnostic decision
3.1.1. Rheumatoid arthritis
3.2. Mechanism
3.2.1. multy factorial
3.2.1.1. genes
3.2.1.2. envairomental factors
3.2.1.2.1. like smoking
3.3. Presentation
3.3.1. morning steffness
3.3.2. symmetrical joints involvment
3.3.3. pain
3.3.3.1. chronic
3.3.4. spleenomegaly
3.3.5. swelling
3.3.6. loss of function
3.3.7. inability to work as usual
3.4. Supporting data
3.4.1. family history
3.4.2. lab results
3.4.3. anti ccp antibodies
3.4.4. crp
3.4.5. elevated white cell count
3.4.6. radiographic changes