Musculoskeletal System


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M46_F2.jpg"}},{"insert":"\n\n\u0022You\u0027re welcome! Have a great day,\u0022 you reply as your patient leaves the consulting room.\n\nYou ask for the next patient to be let in, only to be surprised when Mr. Pierre, your old grade school teacher, comes in. He looks distinctly uncomfortable and limps towards the chair offered.\n\n\u0022I hope you remember me doctor! It\u0027s been a while, and I\u0027m a lot older now \u2013 63 to be exact!\u0022 he laughs.\n\n\u0022Of course, why wouldn\u0027t I?\u0022 you reply with a smile, and then follow up with an inquiry as to why he is here.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M46_F4.jpg"}},{"insert":"\n\n\u0022I woke up this morning with probably the worst pain I\u0027ve ever felt,\u0022 he starts off.\n\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.\n\nYou glance at the affected toe and note that it is swollen, with a diffuse reddish discoloration.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M46_F5.jpg"}},{"insert":"\n\nMr. Pierre denies having had similar swellings in the past. There is no history of preceding trauma, insect bites, or fever. On 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\nApart from obesity there is no significant past medical history.\n\nHis social history reveals a 14 to 15 unit per week alcohol intake. \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 When asked about tobacco use, he replies in the negative.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M46_F4.jpg"}},{"insert":"\n\nYou proceed to examine him, and note the following vital parameters: temperature 37.9 \u00b0C (100.2 \u00b0F), blood pressure 130\/76 mmHg, pulse rate 90\/min, respiratory rate 16\/min.\n\nExamination of the left first metatarsophalangeal joint reveals a 2 x 2 cm erythematous swelling that is extremely tender with mild differential warmth. Both 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"}]}


{"ops":[{"insert":"You strongly suspect that Mr Pierre has acute gout, and proceed to explain this to him. You also clarify the need to rule out other potential differentials first.\n\nHow will you confirm the diagnosis?\n"}]}
1. X-rays of the affected joint
2. Arthrocentesis
3. Serum uric acid levels