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Cme: Gout: Presented By: 1.muhammad Ihfaz Bin Ismail 2.sri Salwani

A 56-year-old Chinese man who smokes and drinks alcohol presented with 2 days of acute pain and swelling in his left knee and big toe after drinking. He has a history of hypertension, diabetes, and obesity. On examination, he had tender swelling of the left knee and big toe joints. Laboratory tests found elevated uric acid levels and crystals in the joint fluid confirming the diagnosis of acute gouty arthritis. Differential diagnoses included septic arthritis and rheumatoid arthritis.

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Sri Salwani Idris
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44 views14 pages

Cme: Gout: Presented By: 1.muhammad Ihfaz Bin Ismail 2.sri Salwani

A 56-year-old Chinese man who smokes and drinks alcohol presented with 2 days of acute pain and swelling in his left knee and big toe after drinking. He has a history of hypertension, diabetes, and obesity. On examination, he had tender swelling of the left knee and big toe joints. Laboratory tests found elevated uric acid levels and crystals in the joint fluid confirming the diagnosis of acute gouty arthritis. Differential diagnoses included septic arthritis and rheumatoid arthritis.

Uploaded by

Sri Salwani Idris
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
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Cme: gout

Presented by : 1.Muhammad Ihfaz Bin Ismail 2.Sri Salwani

Case senario
A 56 years/Chinese man/Smoker/Alcoholic He is known case of Hypertension/DM/Obese He presented with 2 days history of acute pain and swelling of left knee joint and left big toe after drinking alcohol.

FURTHER QUESTION ?
ONSET OF PAIN AND RECURRENT ? ANY SIMILAR SX BEFORE? IS IT INVOLVE ANY OTHER JOINT? HOW LONG DOES PAIN LAST? OTHER PRECIPITATING FACTOR? OTHER ASSOCIATING SX?-FEVER,HAIR LOSS,RAYNAUDS PHENOMENON,MOUTH ULCER

FURTHER QUESTION?
RISK FACTOR :? SMOKER CHRONIC ILLNESS-VERY ILL(DEHYDRATED) HYPERLIPIDEMIA ALCOHOLIC RENAL PROBLEM (CHRONIC RENAL FAILURE) THIAZIDE DIURETIC

FURTHER QUESTIONING?
SIMILLAR SX IN OTHER FAMILY MEMBER?

PHYSICAL EXAMINATION?
PT IS ALERT AND PINK XANTHELESMA OVER EYEBROW BP: 150/90 BMI:30KG/M2 PR:94/MIN REGULAR

PHYSICAL EXAMINATION
TENDER AND SWOLLEN OF LEFT KNEE JOINT AND 1ST LEFT MTP JOINT NO RASH/ TOPHI OTHER SYSTEM NORMAL

WHAT IX TO PROCEED WITH


1)BASELINE: FBC BUSE/CREAT/SERUM URIC ACID RBS FSL URINALYSIS ECG

IX TO PROCEED WITH?
2) SPECIFIC IX TO CONFRIM: JOINT ASPIRATION/CRYSTAL IDENIFICATION

3) LOOK FOR COMPLICATION RENAL IMAGING SKELETAL X-RAY

CASE IX
TWC:11.5 HB:14 PLT: 250 CREAT:90 ANA:NEGATIVE RFPOSITIVE :1:40 URIC ACID 760MICROML/L FSL:TC:6.1 LDL:4.7 TG:3.2

CASE IX
-UFEME:PROTIEN 1+, RBC: 3+ -LFT:ALT:15 AST:17 ALB:39 -ECG: SR 70/ MIN,T INVERSION AT LEAD V5 V6 , AND LVH

WHAT IS YOUR PROVISIONAL DIGNOSIS?


ACUTE GOUTY ARTHRITIS

WHAT IS YOUR DDX


SEPTIC ARTHRITIS RHEUAMATOID ARTHRITIS

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