Jointed

Musculoskeletal System


0

{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M46_F1.jpg"}},{"insert":"\n\n"},{"insert":"\u0022You\u0027re welcome! Have a great day\u0022, you reply as your patient leaves the consulting room.\r\n \r\nThe nurse comes in with another stack of folders to add to the already tall pile on your desk.\r\n \r\n\u0022Just like a hydra\u0022, you silently observe.\n"}]}

1

{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M46_F2.jpg"}},{"insert":"\n\n"},{"insert":"You ask for the next patient to be let in, only to be surprised when Mr. Pierre, your old grade school teacher, comes in.\r\n \r\nHe looks distinctly uncomfortable and almost limps towards the chair offered.\n"}]}

2

{"ops":[{"insert":"\u0022I hope you remember me doctor! It\u0027s been a while, and I\u0027m a lot older now - 63 to be exact!\u0022, he laughs.\r\n \r\n\u0022Of course, why wouldn\u0027t I?\u0022, you smilingly reply and follow up with an inquiry as to why he is here.\n"}]}

3

{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M46_F4.jpg"}},{"insert":"\n\n"},{"insert":"\u0022I woke up this morning with probably the worst pain I\u0027ve ever felt.\u0022, he starts off.\r\n \r\n\u0022It\u0027s just here, below the big toe\u0022, he adds, gesturing carefully towards his left toe, while carefully attempting to avoid any contact with it.\r\n \r\nYou glance at the affected toe and note that it is swollen, with a diffuse reddish discolouration.\n"}]}

4

{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M46_F5.jpg"}},{"insert":"\n\n"},{"insert":"Mr. Pierre denies having had similar swellings in the past. There is no history of preceding trauma, insect bites, or fever. \r\n \r\nOn a scale of 1 to 10, he quantifies the pain as a 10 upon waking up in the morning, but only a 5 right now.\n\nHis medical history is significant for an episode of ureteric colic, three years ago.\r\n \r\nThis was not investigated in-depth, as Mr. Pierre was \u0022too busy to spend time in hospitals\u0022.\n"}]}

5

{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M46_F6.jpg"}},{"insert":"\n\n"},{"insert":"His social history reveals a 14 to 15 unit per week alcohol intake.\r\n \r\n\u0022I wasn\u0027t much of a drinker earlier\u0022, he adds, \u0022but after retiring at the age of 60, I just seem to end up having a couple of drinks every day\u0022.\n\nWhen asked about tobacco use, he replies in the negative.\n"}]}

6

{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M46_F7.jpg"}},{"insert":"\n\n"},{"insert":"You proceed to examine him, and note the following vital parameters:\r\n \r\nTemperature: 37.9 \u00b0C (100.2 \u00b0F); blood pressure: 130\/76 mmHg; pulse rate: 90\/min; respiratory rate: 16\/min.\n"}]}

7

{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M46_F4.jpg"}},{"insert":"\n\n"},{"insert":"Examination of the left first metatarsophalangeal joint reveals a 2 x 2 cm erythematous swelling that is extremely tender with mild differential warmth.\r\n \r\nBoth active and passive movement across the joint is also reduced. No other joint swellings are noted.\n\nThe remainder of the examination reveals no abnormalities.\n"}]}

8

{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M46_F9.jpg"}},{"insert":"\n\n"},{"insert":"You strongly suspect that Mr Pierre has an acute gouty attack, and proceed to explain this to him.\r\n \r\nYou also clarify the need to rule out other potential differentials first.\n"}]}

9

{"ops":[{"insert":"How will you confirm the diagnosis?\n"}]}
1. X-rays of the affected joint
2. Arthrocentesis
3. Serum uric acid levels

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