ROGER’S PAINFUL TOE

ROGER’S PAINFUL TOE

1. 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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