Rheumato Q

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Rheumato Q

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6 Posts

indidoc1
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Topics: 50
Posts: 978

11/21/07 - 10:40 AM

This is a scenario frm kaplan notes...
m numbering the Qs n answering them below..

A 32-year-old man comes with a history of right ankle swelling that occurred the night before. He has noticed that his ankle has been red, warm, and very painful. He has no prior medical history and takes no medications. He has not had recent trauma to his ankle. He occasionally drinks alcohol. On examination you find a red swollen ankle with evidence of an effusion. The range of motion is restricted.

1) What is the first step in this patient?

2)What do we do after confirming the diagnosis?

Six months after the first episode he comes back to your office with left knee swelling. A red, warm knee is noted on examination.

3)What is the first step now?

4)What do you do after confirming the diagnosis?

On a routine visit the same patient has had four documented episodes of gout despite limiting alcohol and diet.

5)What would be the appropriate next step here?

You have decided, because of his job, to place him on allopurinol 300 mg. Dd. He does very well for more than 2 years with no gouty attacks. He then experiences another episode of right ankle swelling.

6)What do you do now?

my answers...

1) Synovial fluid analysis
2) Rx acute gout... NSAIDs / steroids
3) Synovial fluid analysis
4) NSAIDs/steroids again
5) Put him on a uric acid lowering agent... Probenecid or allopurinol
6) raised eyebrow

synovial fluid analysis again??? confused

PS- Whats this relationship between his job n prescribing allopurinol? raised eyebrow

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sprint123
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11/21/07 - 01:52 PM

I think ..for question 5----> We must figure out the 24 hour uric acid excretion to classify over-producers Vs underexcretors for choosing the drug allopurinol or probenecid

tamerbashir
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Topics: 20
Posts: 284

11/21/07 - 03:22 PM

5- NSAID AND COLCHICINE AS PROPHYLAXIS BEFORE START ALLOPURINOL
6- PROBENECID raised eyebrow

indidoc1
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Topics: 50
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11/22/07 - 06:53 AM

sprint123 wrote:
I think ..for question 5----> We must figure out the 24 hour uric acid excretion to classify over-producers Vs underexcretors for choosing the drug allopurinol or probenecid

yes, we always do. nod

In this Q, we chose allopurinol... coz they say so grin

what to do in 6?? u agree wth synovial fluid analysis again?
raised eyebrow

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indidoc1
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11/22/07 - 07:01 AM

tamerbashir wrote:
5- NSAID AND COLCHICINE AS PROPHYLAXIS BEFORE START ALLOPURINOL
6- PROBENECID raised eyebrow

about not using colchicine in (5)... i quote frm CMDT 2008..

" colchicine can be used to prevent future attacks. For the person who has mild hyperuricemia and occasional attacks of gouty arthritis, chronic colchicine prophylaxis may be all that is needed. "

This person hs already has 4+2 = 6 attacks.. i think that justifies the use of uric acid lowering agents.

More inputs needed on Q-6. what to do in a patient on allopurinol presenting wth inflamed joint? raised eyebrow

I chose syn. fluid analysis to make sure he's got gout again... but ... not sure confused

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indidoc1
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11/23/07 - 05:47 AM

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