1. How do you approach the physical
examination for this patient?
Laxchimi

2. History
General
• Pain starts suddenly, often during the night and is often described as throbbing,
crushing, or excruciating.
• men over the age of 30 years
• women after menopause
• family history of gout
• hypertensive and fond of alcohol
• uncontrolled administration of diuretics or aspirin
Acute Gout
• sudden onset of severe joint pain which lasts for aweek or two before resolving
completely
• usually comes out of the blue but may be precipitated by minor local trauma,
operation, intercurrent llness (high blood pressure, high cholestrol etc),
unaccustomed exercise or alcohol consumption
Chronic Gout
• Recurrent acute attacks may eventually merge into polyarticular gout
• Joint erosion causes chronic pain, stiffness and deformity
• calculi, due to uric acid precipitation in the urine, and parenchymal disease due to
deposition of monosodium urate from the blood

3. Physical Examination
Findings
Look
•obese
•rubicund
•skin looks red and shiny and there is considerable
swelling (commonest sites are the
metatarsophalangeal joint of the big toe, the ankle
and finger joints, and the olecranon bursa)
•Tophi may appear around joints over the
olecranon, in the pinna of the ear
•A large tophus can ulcerate through the skin and
discharge its chalky material.

4. Physical Examination
Findings
Feel
Joint feels hot and extremely tender
Move
Range of movement of affected joint
reduced
(do not move when patient is in pain)