Chapter 27 Rheumatology Flashcards
How does gout present?
Severe acute pain and swelling on the right big toe worsening overnight
What is the differential diagnoses for an acute monoarticular joint pain?
Gout, Pseudo gout, septic arthritis, trauma, rheumatoid arthritis, Rieter’s syndrome, Lyme disease
What is a focus physical examination for this patient?
Skin joints and extremity examinations… Lung heart abdominal genital lymph nodes
What are the diagnostic test that should be ran for a patient with tender swollen MTP joint?
CBC, BMP, PT/INR, PTT, serum uric acid, synovial fluid analysis of the effected joint, ESR, x-ray of the joint
When should treatment be initiated for this patient?
When lab results are pending
What does the fluid aspiration analysis consist of?
Cell count and differential, Gram stain, culture and sensitivity, viscosity, microscopy for crystal evaluation
What pharmacotherapy should be used pending lab results?
NSAIDs (naproxen, indomethacin)
What are the contraindications for NSAIDs? What should be done thereafter?
Renal failure, heart failure, and NSAID allergies, PUD; intra-articular or oral steroids
What should be given if the patient has contra indications for NSAIDs and steroids?
Colchicine should be administered
What are the side effects for Cholcine?
Diarrhea nausea and vomiting, abdominal cramps
What does allopurinol used for? How should it not be used?
Used to prevent recurrent gout, should not be used in acute Gouty arthritis because it may worsen the acute attack
What we should be recommended in counseling for gout patients?
Aspirin and diuretics should be avoided if possible, excessive amounts of alcohol and purine rich foods should be avoided, weight loss via diet and exercise if patient is obese… Low protein diet, no alcohol, no smoking, no aspirin, medication compliance
When should the joint aspiration be done?
Immediately after physical examination
When should the empiric treatment for acute gout be done?
After arthrocentesis
The patient have to go to the ER/ward?
No
