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17542483
ROGER’S PAINFUL TOE
Description
Mind Map on ROGER’S PAINFUL TOE, created by Zainab Kamal on 01/04/2019.
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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Resource summary
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
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
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
chronic flare
allopurinol
feboxostat
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
investigations
ESR
urate level
X-RAY
FBC
joint aspiration
complications
Recurrent gout (chronic gouty arthritis)
Tophi
Kidney stones
Kidney disease
result
high WBCS
high Uric acid
high ESR
medication induce gout
Diuretics
aspirin
Niacin
Cyclosporine
Levodopa
physical examination findings
obese
rubicund
ulcers
red & shiny skin
tophi around joints
swelling of metatarsal joints
DDX
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