USMLE Forum Archives - USMLE Step 3 - Rheum- Big Toe Swelling
Rheum- Big Toe Swelling
harry206 - 05-10-09 10:26
A 55-year-old Caucasian man comes to the physician with complaints of severe pain and swelling in his right big toe. He has a past medical history of hypertension, osteoarthritis, and peptic ulcer disease. His medications include hydrochlorothiazide, acetaminophen, naproxen, and cimetidine. On physical examination, his first metatarsophalangeal joint has diffuse swelling, and the skin surrounding the joint is erythematous. His joint is exquisitely tender to palpation, and has severe restrictions in movement. Aspiration of the joint fluid reveals the presence of multiple needle-shaped negatively birefringent crystals within the polymorphonuclear cells. You start the patient on colchicine. The next day, the patient says that the severity of the pain has markedly decreased. His uric acid level is 8.7 mg/dL, serum creatinine is 1.4 mg/dL, and his liver function tests are within normal limits. Which of the following should be done to reduce the recurrence of acute gouty attacks?
harry206 - 05-10-09 10:26
A 55-year-old Caucasian man comes to the physician with complaints of severe pain and swelling in his right big toe. He has a past medical history of hypertension, osteoarthritis, and peptic ulcer disease. His medications include hydrochlorothiazide, acetaminophen, naproxen, and cimetidine. On physical examination, his first metatarsophalangeal joint has diffuse swelling, and the skin surrounding the joint is erythematous. His joint is exquisitely tender to palpation, and has severe restrictions in movement. Aspiration of the joint fluid reveals the presence of multiple needle-shaped negatively birefringent crystals within the polymorphonuclear cells. You start the patient on colchicine. The next day, the patient says that the severity of the pain has markedly decreased. His uric acid level is 8.7 mg/dL, serum creatinine is 1.4 mg/dL, and his liver function tests are within normal limits. Which of the following should be done to reduce the recurrence of acute gouty attacks?
The correct answer and explanation will be available after you answer.
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#2
Re: Rheum- Big Toe Swelling bingousmle - 05-10-09 12:46 My answer is: b.
allopurinol is a xanthine oxidase inhibitor and blocks uric acid production, its relatively safe for the kidneys. other indication to use allopurinol to avoid gout is alongwith chemotherapeutic agents
#12
Re: Rheum- Big Toe Swelling mtniharika - 09-15-09 13:12 excellent question...
thiazides can exacerbate a tendency toward diabetes and, rarely, cause attacks of gout.
#19
Re: Rheum- Big Toe Swelling babbu5508 - 09-30-10 09:02 My answer is: b.
allopurinol is a xanthine oxidase inhibitor which therefore reduces the production of gout and therefore used in chronic gout...
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