5.A 63-year-old male construction worker presents to the primary care physician with difficulty using his left elbow over the past few days. He states that he is unable to bend it easily and it is hot to the touch and painful. On examination, the elbow is red, swollen, and tender to light touch (Figure 2). There are no other areas of swelling or erythema. He denies fever, recent trauma, or previous history of joint problems. He drinks a 6-pack of beer daily and smokes 1 pack of cigarettes per day. He states that his father and 2 brothers have gout. Aspiration of joint reveals thick yellow fluid. Microscopic examination of the aspirate reveals many white blood cells, red blood cells, and thin, needle-shaped crystals that are both intracellular and extracellular. What is the next step in this patient™s management?
A. Inject steroids
B. Start allopurinol
C. Start antibiotics
D. Start oral colchicine
1. An 18-year-old football player is referred for evaluation of severe muscle cramping that occurred during games and elevated creatine kinase (CK) levels. On further questioning, he reports that he had similar muscle cramps as a wrestler in middle school when he restricted caloric intake and used a garbage bag under his clothes to manage his weight. What syndrome is suggested by this patient™s acute episodes of pain with prolonged exertion?
Benign muscle fasciculation
Duchenne™s muscular dystrophy
Inclusion body myositis
Inflammatory myopathy
Storage diseases
Q5. If it is just one joint the best initial treatment intra articular ingection steroids
if polyatticular involvement the best systemic steroids
if steroids contraindicated next best colchicine oral
then attack resolved the best allopurinol
let me try the first question.
pt with acute gout ---> nsaids--->c/i---> colchicine --->if c/i ----> steroids.
no c/i for colchicine in this patient (except he is drinking 6 beers/day --->can this cause hepatic dysfunction ??)
so I will go with D. Colchicine.
Good point viven.
yea this patient have only one joint invloved, and colchicine have narrow therapeutic window and risk of toxicity.
may be intra articular steroid is the best option here
Good qs, waiting for the answer.
thanks for the responce friends.....but Correct ans is C
??????????
wao...this is shocking
plz explain.
Thanks
Gout have high WBC in synovial fluid
Start antibiotics. Although it appears that this patient has acute gout, infection should be carefully considered, particularly because there is no prior history of an acute inflamed bursa or joint. If the results of culture rule out infection, then the olecranon bursa can be injected safely with steroids to help minimize pain and swelling. Oral colchicine can be administered concurrently with antibiotic treatment; however, many rheumatologists avoid aggressive colchicine treatment due to the side effects (ie, diarrhea).5 Allopurinol should not be started during an acute attack because it can prolong or worsen the attack.
Thanks vir.
very good question.
found this info from emedicine:-
** Intra-articular corticosteroids are particularly useful in patients with a monoarticular flare to help reduce the systemic effects of oral steroids. Ensuring that the joint is not infected prior to injecting intra-articular corticosteroids is particularly important **