17542483
Description
Mind Map by Zainab Kamal, updated more than 1 year ago
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Created by Zainab Kamal
over 5 years ago
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ROGER’S PAINFUL TOE
- a 50 yrs, with painful Lt. great toe from 2 days
after attending dinner party
- signs & symptoms
- sudden sever joint pain
- joint swelling
- joint stiffness
- mild fever
- sudden sever joint pain
- consumed at least 5 beers, lots of sea food, m no truma
- mild swelling in his knees with excessive walking
- PMH: HTN, hyperlipidemia, impaired glucose tolerance,
history of kidney stones
- on medications: bendrofluazide, losartan, atenolol,
fenofibrate, and aspirin.
- high- protein, low-carbohydrate diet, light drinker
- risk factors
- Alcohol
- genetics
- chronic kidney disease
- high purine food
- diabetes
- Alcohol
- lab test: WBC count of 14500/cm3, ESR 32
mm/first hr, His blood uric acid was 10 mg/dl,
- Diagnoses gout and prescribed indomethacin
- RX:
- acute flare
- anti-inflammatory
- NSAIDS
- colchicine
- glucocorticoids
- NSAIDS
- anti-inflammatory
- chronic flare
- allopurinol
- feboxostat
- allopurinol
- acute flare
- After 6 weeks he came with a severely swollen left knee
- Done X-rays and performs knee joint aspiration
- injected knee with a mixture of
triamcinolone and lidocaine
- advised to change dietary habits, eat more
vegetables and fruits, avoid red meat and
reduce alcohol intake.
- No further episodes of a painful toe.
- life style modifications
- limit: sea food, salt, sugar
- increase low fat, and non-fatty
diary products, vegetables
- avoid meat, alcohol
- limit: sea food, salt, sugar
- No further episodes of a painful toe.
- advised to change dietary habits, eat more
vegetables and fruits, avoid red meat and
reduce alcohol intake.
- investigations
- ESR
- urate level
- X-RAY
- FBC
- joint aspiration
- ESR
- injected knee with a mixture of
triamcinolone and lidocaine
- complications
- Recurrent gout (chronic gouty arthritis)
- Tophi
- Kidney stones
- Kidney disease
- Recurrent gout (chronic gouty arthritis)
- Done X-rays and performs knee joint aspiration
- RX:
- result
- high WBCS
- high Uric acid
- high ESR
- high WBCS
- Diagnoses gout and prescribed indomethacin
- risk factors
- medication induce gout
- Diuretics
- aspirin
- Niacin
- Cyclosporine
- Levodopa
- Diuretics
- high- protein, low-carbohydrate diet, light drinker
- physical examination findings
- obese
- rubicund
- ulcers
- red & shiny skin
- tophi around joints
- swelling of metatarsal joints
- obese
- on medications: bendrofluazide, losartan, atenolol,
fenofibrate, and aspirin.
- PMH: HTN, hyperlipidemia, impaired glucose tolerance,
history of kidney stones
- DDX
- mild swelling in his knees with excessive walking
- signs & symptoms
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