lucky
Forum Guru
Topics: 23
Posts: 505
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a 32yr. man with a hx. of right ankle swelling that occured the night before.he has noticed that his ankle has been red, warm, and vert painful.no prior medical hx. and no medications.he has not had recent trauma to his ankle. occasionally drinks alcohol.
on exam. a red swollen ankle. with evidence of an effusion.restricted range of motion,
:arrow: what is the first step inthe management of this pt.
:arrow: what do we do after confirming the dx.
6 mo. after the 1st episode he comes in with left knee swelling. red warm knee on exam.
:arrow: what is the first step now.
:arrow: what do u do after confirming the dx.
[ rheum.kap int. med.]
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| daira
Forum Senior
Topics: 29
Posts: 138
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First time: First step would be joint aspiration and treatment would be Indomethacine and Colchicine.
2nd time: should we do joint aspiration again? I think yes. and treat the same way for acute attacks.
After the pt is stable we can do serum uric acid levels & 24hrs urine and then put him on probenicid or alluporinol.
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| lucky
Forum Guru
Topics: 23
Posts: 505
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thanks qalander.
in kaplan it says that serum uric acid is not sucha good test for gout.
shouldn't we put him on allupurinol or probenecid after the acute attack subsides.
the second time too he comes in with an acute attack, so do we treat him the same way as the first time?
[this is very confusing]
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| dimps
Forum Guru
Topics: 63
Posts: 446
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hi lucky
kaplan says s.uric acid is not a good test in "acute" attack ,but for for chronic hypouricemic therapy it is helpful
ya even i think we should put him on allupurinol or probenecid after the acute attack subsides
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| lucky
Forum Guru
Topics: 23
Posts: 505
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thanks dimps.
the second time he is coming with an acute attack again. so do we put him oncolchicine ?
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