100 Cases in Clinical Medicine by John Rees, James Pattison, Gwyn Williams

By John Rees, James Pattison, Gwyn Williams

This article covers middle fabric in scientific drugs. masking the key structures in 15 sections, every one part comprises 8 situations. those situations replicate these which scholars and condominium officials will meet in outpatients and normal perform. disguise; booklet identify; Contents; Preface; Acknowledgements; Abbreviations; part 1: Systems-related circumstances; part 2: common self-assessment circumstances; Index

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Other seronegative arthritides: ankylosing spondylitis, psoriatic arthropathy. Viral arthritis: usually polyarticular. Acute rheumatoid arthritis: usually polyarticular. Acute gout: most commonly affects the metatarsophalangeal joints. Pseudogout: caused by sodium pyrophosphate crystals; often affects large joints in older patients. Lyme disease: caused by Borrelia burgdorfii infection transmitted by a tick bite; may have the characteristic skin rash – erythema chronicum migrans. Haemorrhagic arthritis: usually a history of trauma or bleeding disorder.

Acute gout: most commonly affects the metatarsophalangeal joints. Pseudogout: caused by sodium pyrophosphate crystals; often affects large joints in older patients. Lyme disease: caused by Borrelia burgdorfii infection transmitted by a tick bite; may have the characteristic skin rash – erythema chronicum migrans. Haemorrhagic arthritis: usually a history of trauma or bleeding disorder. This patient should have urethral swabs taken to exclude chlamydial/gonococcal infections, and the appropriate antibiotics given.

Pseudogout is caused by deposition of calcium pyrophosphate crystals and would be expected to show calcification in the articular cartilage in the knee joint. The X-rays here show some joint space narrowing but no calcification in the articular cartilage. The fever, high white cell count and ESR are compatible with acute gout. The raised glucose may also be a side-effect of thiazide diuretics. If this remains after the acute arthritis has subsided then it may need further treatment. Precipitation of gout by thiazides is more likely in older women, particularly in the presence of renal impairment and diabetes.

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