usmlejedi
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A 70-year-old man presents with a complaint of intense pain from a red and swollen right toe. He has had no prior events such as this. He cannot recall trauma to the toe. An x-ray film of the right foot is negative for a fracture. He is taking no medications, and denies a history of alcohol abuse. He is given a diagnosis of gout and his serum is drawn for analysis. Which of the following findings would be most helpful in making the diagnosis of gout in this patient?
A. Associated right ankle effusion
B. Painless elbow nodule
C. Response to colchicine
D. Serum uric acid elevation
E. X-ray film showing first metatarsophalangeal joint erosion
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| kpmle2
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C. Response to colchicine
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| doc_clotaire
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D. Serum uric acid elevation
I will do that first ,even if it is it not accurate but can be helpful
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| kpmle2
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uric acid levels will be elevated or it can be normal in some patients.
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| Doc750
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no FNA?
doc_clotaire .. I agree about doing serum uric acid levels .. but it's not diagnostic.
so by default I would pick C
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| gordon
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I bet on C.
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| starcraftbw
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C. via elimination
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| elitoki
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The Q's said "....to help to diagnosis." I don't think, a good response to medication helps you to diagnose.
I might be wrong, but colchicine helps to decrease inflamation caused by urate crystal on articulation, that means, finding elevate uric acid level in serum will helps more to find out Gout. No matter if the result of urate is elevation or normal you have to latter on do arthrocentesis to confirm diagnosis.
My answer is D.
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| Doc750
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but elevated uric acid levels is a nonspecific finding, not a "make the diagnosis" finding.
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| Dr.D
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uric acid level may be elevated or normal. I will go for C.
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| Justice
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D. Serum uric acid elevation
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| Justice
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colchicine will start working on the next day after you give it, by "paralyzing" PMNs, unlike indometacin... I doubt this is diagnostic feature...
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| usmlejedi
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Are you sure?
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| Justice
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usmlejedi wrote:
Are you sure?
If this Q is to me, then I am...
Colchicine should be taken within the first 12 hours of the attack and usually relieves the pain within 48 hours
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| suv
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could it be E?
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| spmvj
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Joint erosions will be present if there are multiple attacks of gout.But this pt has had no prior complaints in the past.
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| Ivonne
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C. Rule out: A clinical response to colchicine is not pathognomonic for gout and can be seen with pseudogout, sarcoid arthropathy, psoriatic arthritis, and calcific tendonitis.
D. Rule out: Serum uric acid
- This is the most misused test in the diagnosis of gout.
- Five to eight percent of the population has elevated serum uric acid levels (>7 mg/dL), but only 5-20% of patients with hyperuricemia develop gout. Thus, the presence of an elevated level of serum uric acid does not mean the patient has gout or will develop gout. Gout is diagnosed by finding urate crystals in the synovial fluid or soft tissues.
B No
A. I will go for A because I will be able to analize sinovial fluid.
E .Plain radiographs may show findings consistent with gout, but these findings are not diagnostic. The most common radiographic finding early in the disease is soft-tissue swelling or a normal radiograph.
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| Ivonne
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ha, just found the answer. It is C
The correct answer is C. A good way to diagnose gout is to give oral colchicine hourly until the patient develops improvement in joint pain and inflammation. The most specific method of diagnosis, however, is joint aspiration and identification of negatively birefringent needle shaped crystals.
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| mjl1717
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Ivonne wrote:C. Rule out: A clinical response to colchicine is not pathognomonic for gout and can be seen with pseudogout, sarcoid arthropathy, psoriatic arthritis, and calcific tendonitis. D. Rule out: Serum uric acid - This is the most misused test in the diagnosis of gout.
- Five to eight percent of the population has elevated serum uric acid levels (>7 mg/dL), but only 5-20% of patients with hyperuricemia develop gout. Thus, the presence of an elevated level of serum uric acid does not mean the patient has gout or will develop gout. Gout is diagnosed by finding urate crystals in the synovial fluid or soft tissues.
B No A. I will go for A because I will be able to analize sinovial fluid. E . Plain radiographs may show findings consistent with gout, but these findings are not diagnostic. The most common radiographic finding early in the disease is soft-tissue swelling or a normal radiograph.
where do you get your info about colchicine?
most accurate test would be synovial tissue biopsy!!
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| Ivonne
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mjl1717 have fun with this link:
http://www.emedicine.com/med/topic924.htm
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