Reference no: EM133585285

Question

Patient is a 64-year-old white male with past medical history notable for hypertension, obstructive sleep apnea, obesity, and GERD who presented to his primary care office for evaluation of right foot swelling and pain. He reports swelling and pain to his right foot for the past 5 days. When asked where the pain was, he pointed to the first metatarsophalangeal (MTP) joint of his right foot. His pain is exacerbated by walking and putting weight on it. He denies injury to the area. He has tried ibuprofen, Voltaren gel, ice, and elevation with some relief. He has taken the past few days off from work due to the pain. He reports one past episode of gout about 3 years ago that felt similar to this. He reports having a few beers on the weekends and enjoying seafood multiple times a week. He denies fevers at home. Upon physical exam, his right foot is swollen with no warmth to the touch. 2+ pedal pulses present. He is diagnosed with a gout flare and prescribed 40mg PO Prednisone for 5 days. Patient educated to maintain a low purine diet and to avoid foods including alcohol, red meats, deli meats, seafood, and sugary snacks high in fructose corn syrup. Patient educated that if symptoms do not greatly improve in 24-48 hours, to return to office for reevaluation. NP states that he may be started on prophylactic allopurinol if he has more flare ups in the future. No labs or imaging ordered at this time.