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ROGER’s Painful Toe

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Mind Map on ROGER’s Painful Toe, created by Fatima Alkhateeb on 29/03/2019.
Fatima Alkhateeb
Mind Map by Fatima Alkhateeb, updated more than 1 year ago
Fatima Alkhateeb
Created by Fatima Alkhateeb about 5 years ago
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Resource summary

ROGER’s Painful Toe
  1. Biochemistry of purine metabolism
    1. DDx of Big Toe Pain
      1. Trauma
        1. Arthritis
          1. Hallux Valgus (Bunion)
            1. Hallux rigidus
            2. Sesamoiditis
            3. Gout
              1. Primary gout (90%)
                1. Overproducation of uric acid
                  1. Decreased excretion of uric acid
                    1. Alcohol consumption
                      1. Renal failure
                      2. Diet (seafood, red meat)
                        1. Fructose containing cyrup
                          1. Chemotherapy, radiotherapy
                        2. Secondary gout (10%)
                          1. Increased cell turnover
                            1. Inborn errors of metabolism
                          2. Pathogenesis
                            1. Risk factors
                              1. Age
                                1. Genetics
                                  1. Obesity
                                    1. Medications
                                      1. Thiazides
                                        1. Low-dose aspirin
                                2. Signs and symptoms
                                  1. Podagra
                                    1. Tophi
                                      1. Swollen inflamed joint
                                    2. Complications
                                      1. Joint deformity
                                        1. Osteoarthritis
                                          1. Renal stones
                                            1. Sinus may be infected
                                3. Pseudogout
                                  1. Deposition of Calcium Pyrophosphate crystals
                                    1. Causes
                                      1. Hyperparathyroidism
                                        1. Hemochromatosis
                                          1. Etidronate disodium therapy
                                            1. Angiography
                                  2. Investigations
                                    1. X-ray
                                      1. CBC
                                        1. Joint aspiration
                                          1. Biochemical tests
                                            1. Uric acid levels
                                              1. BUN levels
                                    2. Management
                                      1. Acute gouty arthritis
                                        1. NSAIDs
                                          1. Corticosteroids
                                            1. Colchicine
                                        2. Hyperuricemia
                                          1. Xanthine oxidase inhibitors
                                            1. Uricoseric drugs
                                              1. Probenecid
                                                1. Pegloticase
                                              2. Allopurinol
                                          2. Prognoisis
                                            1. Treatable with good prognosis if treated directly

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