1602102069 LONG CASE
45 year old male patient who is a farmer by occupation , chronic alcoholic
Presented to opd with
History of swelling & pain at right first metatarsal joint since 5 months.
B/l ankle joint & left knee joint pain & swelling associated fever since 1 week
Low back ache since 3 days
Restriction of movement present at left knee joint and b/l ankle joint
Fever since 1 week - low grade , intermittent , decrease with medication
No h/o small joint involvement
No h/o early morning stiffness
No h/o pain/restriction of movements at UL joints
No h/o rash
No other complaints
Past history:
No h/o DM/HTN/Asthma/Epilepsy/CAD/TB
Personal history:
Diet : mixed
Sleep : adequate
B&B : regular
Addictions : chronic alcoholic since 20 yrs
General examination:
Patient c/c/c
Pallor +
PR: 62 bpm
BP: 110/70 mmhg
Local examination:
Swelling , local rise of temp & Tenderness present at right 1st MTP joint, right ankle joint
& left knee joint.
Systemic examination:
CVS:
Elliptical & b/l symmetrical chest
No visible pulsations/engorged veins/ scars/sinuses on the chest wall
Apex beat palpable at 5th intercostal space medial to midclavicular line
S1 , S2 heard
No murmurs
RS:
Elliptical & b/l symmetrical chest
Trachea appears to be central
Expansion of chest equal on both sides
B/l air entry +, normal vesicular breath sounds
P/A:
Scaphoid abdomen
No visible pulsations/engorged veins/scars/sinuses
Soft , no organomegaly
No free fluid in the abdomen
Bowel sounds present
CNS:
Conscious and alert
Normal gait
Normal speech
No signs of meningeal irritation
Motor & sensory system normal
Reflexes : superficial and deep tendon reflexes are intact
Cranial nerves : intact
INVESTIGATIONS
X-ray left foot with ankle AP view
X-ray right foot with ankle AP view
ECG
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhGme4LTDdm_MKBvw443S2hJtXUo-nrNnf4OtCDqAidy9dj7lfgeDgIlARZUh4e2aNNg18cbdNkEktP7o2hN-eoLZxtNrZw8heJVTP6-K3SM1aY2uvBFkiXyxRurJDl6r09xmdAVIPFzpI/s1600/1632728019534367-0.png)
USG abdomen
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVMv5xktIUr-HbCme2X60Oh_ggLZehTCdZVx_RE4otIuRd4ehyMPciku5malLowgJ5hefnrdr8zZXHcxl088VlGijS2xy5FjAUDlg9BP1Mac5YMHg9aYh0-aZit47jgDhL9b8sVEumkr8/w396-h275/1632728012840604-1.png)
USG b/l knee joint
Lab investigations
![](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgwdiwlaE0kf75bQWEPVL-BhMUViUp7rfKoz7DuMa_dQUKI0X157F_e5zYbHmVUJqzW579IzdD5scvkV2mQzYcjvwsLIC4H7MPQZTAr_Q_NDO0LlD1coiLUCOfjo4Hc7Gi2BbznNXB2rE4/s1600/1632728207175728-0.png)
Provisional diagnosis:
?Gouty arthritis
Microcytic hypochromic anemia - ? IDA
CKD - ? Analgesic nephropathy/Gouty nephropathy
Treatment:
1) Inj Tramadol 1Amp in 100ml Ns IV/SOS
2) Tab wysolone 5mg PO/OD
3) Tab Colchicine 0.5mg PO/OD
4) BP/PR/Temp/SpO2 monitoring
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