Gout

Question 1

What are the common examination findings?

Answer 1

Inflammed, swollen painfun joint, usually 1st MTP

Tophi on elbows, ear, hands

Question 2

What are the investigations?

Answer 2

To finish the exam i would like to - examine the joint above and below and perform a neurovascular exam if i havent already.

By the bed - History and obs and functional status

FBC for anaemia, U/E for renal function, uric acid levels

ESR/CRP for inflammation

RF to rule out RA

Other - X ray of the joint, joint aspiration for negatively befringed crystals

Question 3

What are the key investigation findings?

Answer 3

Uric acid levels may be raised

U/E may show CKD

Joint aspiration shows characteristic negatively befringed crystals

Question 4

What is the treatment?

Answer 4

Conservative - Explain what it is and lifestyle modifications eg diet, weight, reduce alcohol intake

Medical - Colchicine and NSAIDS (PPI)

Allupurinol prophylaxis

Question 5

What are the risk factors?

Answer 5

Renal disease

Red meat and alcohol

Obesity

Drugs - Thiazide diuretics