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Mr. Lim, a 55-year-old man presents to the Emergency Department of Hospital Shah Alam with the onset of severe sharp pain, redness, and hard swelling on his left big toe since last night.

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Mr. Lim, a 55-year-old man presents to the Emergency Department of Hospital Shah Alam with the onset of severe sharp pain, redness, and hard swelling on his left big toe since last night.

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Alcohol consuming

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Seafood intake

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Lactic acid increase

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Purine degradation increase

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Hyperuricemia

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Increase ESR & CRP : state it results

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Serum uric acid level : state it results

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X-ray : state it results

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Precipitation of monosodium urate at the join

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Pathological changes in cartilage, bone & joint

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Pathological changes in cartilage, bone & joint

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i) Cartilage damage

ii) Bone erosion

iii) Pannus formation

iv) Fibrosis

v) Ankylosis

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Complement cascade activation

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Neutrophils phagocyte the crystal

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Release of ROS & degradative enzyme (matrix-metalloproteinase) at the joint causing inflammation

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Synovial fluid analysis : state its results

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Bigtoe nail dystrophy & discolouration

i) Onychauxis

ii) Onycholysis

iii) Yellowish/brownish discolouration

iv) Subungual hyperkeratosis

v) Peringual skin inflamed

vii) Metatarsophalangeal joint swelling

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insert here (ringkasan je)

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insert here (ringkasan je)

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insert here (ringkasan je)

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Sudden onset of localized pain & swelling

insert here (ringkasan je)

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Insert the classification

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Insert the classification (short & simple)

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i) Joint deformity

ii) Joint damage

iii) Decreased mobility

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i) Anti-inflammatory: Glucocorticoid & NSAID (indomethacin)

ii) Uricosuric agent (probenecid, sulfinpyrazone)

iii) Xanthine oxidase inhibitor (Allopurinol & febuxostat)

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Pathological changes of joints & extra-articular tissues in types of gout

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Pathological changes of joints & extra-articular tissues in types of gout