Scenario: A 47-year-old man presents with “extreme” pain in his right large toe. The man is overweight and has consumed 12 to 16 beers daily for at least 15 years. His medical history includes hyperlipidemia and a history of gall bladder disease but is otherwise unremarkable. Today’s vital signs include blood pressure 180/96, heart rate 89, respiratory rate 24, Temperature 98.8°F, and pain reported as 8 on 1 to 10 scale. The patient has taken acetaminophen and ibuprofen for pain management with little effect. The patient says this is the first time he has experienced such pain. He has not been diagnosed with gout, arthritis, or other conditions in the past. This pain has prevented him from sleeping for 3 nights, and he appears tired. He also reports difficulty walking and completing his daily responsibilities as a farmer. The patient reports recent trauma to the toe as he dropped a heavy object on it 1 week prior; however, no obvious displacement of the joint or bruising is noted. The practitioner suspects gout is the cause of the man’s condition.

1.What risk factors does the man have for developing gout?
2.What contributing factors should be explored with the patient?
3.What would you look for in your physical assessment?
4.What is the initial testing that should be performed after a physical assessment?
5. What are the differential diagnoses for this patient?
6. What modifications should the patient be instructed to make for treatment of the gout?
7. What is your initial treatment and follow up plan? Include full prescribing information.

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