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Roger’s Painful Toe

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Mind Map on Roger’s Painful Toe, created by Alya Almualla on 01/04/2019.
Alya Almualla
Mind Map by Alya Almualla, updated more than 1 year ago
Alya Almualla
Created by Alya Almualla over 5 years ago
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Resource summary

Roger’s Painful Toe
  1. Due to
    1. Gout
      1. Monoarthritis
        1. Differential Diagnosis
          2. Evaluation and clinical approach
            2. Septic Arthritis
              1. Causative agents
              2. Pseudogout
                1. Chondrocalcinosis
                  1. Deposition of calcium pyrophosophate dihydrate crystals
                    1. Calcium pyrophosophate dihydrate disease "CPPD"
                      1. Weakly positively birefringent (blue) rhomboid-shaped crystals
                        2. Large joints (KNEE or wrist) / Other joints
                  2. Periarthritis
                    1. Pain in the joint
                      1. Calcium crystals deposited
                        1. 1-4 weeks
                          1. Hypercalcemic conditions
                            1. Triggered by trauma
                              1. Relieving pain / Self limited
                                1. Confirmed by X-ray / US
                                2. Articular vs. Non-articular
                                  1. ROM
                                    1. Articular
                                      1. Pain on active and passive motion
                                      2. Non-articular
                                        1. Specific motion
                                      3. Tenderness
                                        1. Articular
                                          1. Surface circumference
                                          2. Non-articular
                                            1. Over bony prominence along tendons
                                          3. Pain
                                            1. Articular
                                              1. Generalized, deep or diffuse pain
                                              2. Non-articular
                                                1. Localized
                                            2. Inflammatory vs. non-inflammatory
                                            3. Hyperuricaemia
                                              1. Deposition of Monosodium Urate Crystals
                                                1. Due to purine abnormality
                                                  1. Purine Metabolism
                                                    2. Purine degradation
                                                    3. Negatively birefringent (yellow) needle-shaped crystals
                                                      2. First metatarsophalangeal joint (BIG TOE) / Other joints
                                                    4. Stages
                                                      1. Asymptomatic hyperuricemia
                                                        1. No symptoms / Hyperuricaemia / Crystals are forming in joint
                                                          1. Before the first attack
                                                          2. Acute gout “Gout attack”
                                                            1. Painful arthritic attack of sudden onset
                                                              1. Damage starts
                                                              2. Interval gout
                                                                1. Period between the attacks
                                                                  1. No pain, but a low level of inflammation
                                                                  2. Chronic gout
                                                                    1. Frequencies increase + Chronic hyperuricaemia
                                                                      1. Complications
                                                                        1. Joint damage and chronic pain
                                                                          1. Large subcutaneous tophi
                                                                            1. Deposition of urate crystals in kidney
                                                                              1. Kidney failure
                                                                              2. Destroyed articular cartilage
                                                                                1. Joint deformity and loss of mobility
                                                                                2. Psychological and emotional problems
                                                                          2. Causes and Risk Factors
                                                                            1. Age and gender
                                                                              1. Genetics
                                                                                1. Lifestyle choices
                                                                                  1. Lead exposure
                                                                                    1. Medications
                                                                                      1. Thiazide diuretics
                                                                                        1. Aspirin
                                                                                        2. Weight
                                                                                          1. Recent trauma or surgery
                                                                                            1. Other health problems
                                                                                              1. Renal insufficiency
                                                                                            2. Pathogenesis
                                                                                              2. Investigations
                                                                                                1. Blood test
                                                                                                  1. Joint fluid test (Arthrocentesis)
                                                                                                    1. Radiology
                                                                                                      1. X-ray
                                                                                                        2. US
                                                                                                          1. Dual energy CT scan
                                                                                                        3. Management
                                                                                                          1. Acute
                                                                                                            2. Chronic

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