Objectives

Have a differential diagnosis for nontraumatic joint pain, based on clinical presentation. 2. Become familiar with the most common diagnostic tests for the above conditions, and have a rationale when ordering these tests. 3. Know the most common treatment options in the acute onset of gout and infectious arthritis, as well as the chronic management of rheumatoid arthritis and osteoarthritis. This 45-year-old male presents with the sudden onset of monoarticular joint pain. The lirst diagnosis...

Clinical Pearls

Diabetes is one of the most common diseases in clinical practice. The criteria for diagnosis have been lowered to decrease complications, including death. Type 2 diabetes accounts for more than 90 all diabetes in the United States. The increasing presence of obesity is. unfortunately, driving the incidence of type 2 diabetes even higher. Biguanides are gaining favor in the treatment of type 2 diabetes because of their potency and demonstrated reduction in morbidity and mortality. American...

Definitions

Avascular necrosis Death of living bone tissue caused by disruption of blood flow. Dysplasia Abnormal growth or development. Infants and Toddlers Common causes of limping in children in this age group are septic arthritis, fractures, and complications of congenital hip dysplasia. Septic arthritis is usually monoarticular and associated with systemic signs such as fever. In young infants, the symptoms may be less obvious, such as crying, irritability, and poor feeding. Children who are...

Treatment

Analgesia is a common factor to consider in therapy for all the conditions described above. In the case of an acute gout attack, colchicines, nonsteroidal antiinflammatory drugs (NSAIDs), and glucocorticoids are the drugs mainly used. In the elderly population, one must take into account the possibility of GI complications from the above medications. To reduce these risks, intraarticular steroids, ice packs, and low-dose colchicine are more often used. In patients with recurrent gout attacks,...

Common Viral Infections Roseola

Human herpes virus 6 is a ubiquitous virus that infects most children before the age of 3 years, although most infections are asymptomatic. The virus has an incubation period of 1-2 weeks and causes an illness associated with fever and mild respiratory symptoms, which lends to last for no longer than 5 days. Following defervescence, a characteristic rash appears suddenly. It is an erythematous maculopapular eruption that starts on the trunk and spreads rapidly to the extremities, with sparing...

Clinical Presentation

Gout's first episode can often be confused with cellulitis. It presents with swelling and pain, usually of 1 joint, accompanied by erythema and warmth. Classically, a gout attack involves the metatarsophalangeal joint of the first toe, called podagra, but it may involve any joint in the body. Some cases left untreated resolve spontaneously within 3 to 10 days, with no vesiiluat signs or symptoms. During an acute attack, the serum uric acid level may be normal or even low, likely as a result of...

Approach To Hypercalcemia

The diagnostic approach to hypercalcemia begins with a careful history, including the manifestations of elevated calcium levels. When the aforementioned etiologies are taken into consideration, it becomes clear that the history should include family history of calcium disorders, such as renal stones or malignancy. The patient's risk factors for malignancy, such as smoking, should be investigated. A careful review of medications should also take place, to include not only prescription...

Diagnosis

The test of choice for the determination of the source of lower GI bleeding is colonoscopy. Adequate bowel preparation with an oral sulfate purge to clear the bowel of blood, clots, and stool increases the yield in diagnosing colonic bleeding sites. Angiography and technetium-labeled colloid or red blood cell scans may be of value if colonoscopy cannot be performed or if heavy bleeding prevents adequate visualization of the colon. However, the magnitude of bleeding required to show the bleeding...