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Explore This IssueJuly 2017
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The patient is alert and oriented. Her weight is 185 lbs., her height is 5’6”, and her blood pressure is 125/80. Her lungs are clear. Her heart has a regular rate and rhythm and no murmurs or friction rubs. Her abdomen is soft, nontender, with no mass or hepatosplenomegaly. Her skin color is good, and she has no rashes. Musculoskeletal exam shows her gait is slightly stiff. Her right first toe has warmth, swelling and tenderness. All other joints are unremarkable, with full range of motion and no active synovitis or inflammation.
Assessment & Plan
Synovial fluid is drawn from the right toe MTP (metatarsophalangeal) joint for microscopic examination. This examination shows intracellular, needle-shaped crystals that are birefringent with negative elongation. This confirms a diagnosis of acute gout. The patient is told that this episode may again be related to her treatment with hydrochlorothiazide. Her right first MTP joint is injected with methylprednisolone 10 mg. She is instructed to continue taking the NSAID, and the proper dosage is discussed and written down. She is advised to stay off of her feet as much as possible for the next few days. She is scheduled to return to the office in four weeks and is asked to discuss her hypertension with her primary care physician to determine if it can be controlled with other medicines.
Acute gout of right first MTP joint, likely secondary to hydrochlorothiazide.
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