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.




Left lower limb




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


Chest x-ray



USG abdomen



USG b/l knee joint



Lab investigations


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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