Musculoskeletal

gout = monosodium urate monohydrate, negatively bifringent
psuedogout = calcium pyrophosphate dihydrate

NSAIDs and colchicine
prophylaxis = allopurinol
if already on allopurinol avoid changes in dose
but don't start allopurinol during first acute attack! will exacerbate gout!

* bony tenderness at the lateral malleolar zone (from the tip of the lateral malleolus to include the lower 6 cm of posterior border of the fibular)
* bony tenderness at the medial malleolar zone (from the tip of the medial malleolus to the lower 6 cm of the posterior border of the tibia)
* inability to walk four weight bearing steps immediately after the injury and in the emergency department

reduced knee extension
parasthesia/weakness over anterior thigh
+ straight leg raise

educed knee extension
parasthesia/weakness over anterior knee
+ straight leg raise

young man, LBP and stiffness of onsidious onset
pain at night which improves on getting up
stiffness usually worse in the AM and improves with exercise

slipped upper femoral epiphysis

Perthes: 4-8. limp, stiffness and reduce ROM in hip
slipped epiphysis: knee or thigh pain common, loss of internal rotation during hip flexion

lateral epicondyle

common peroneal

in the third inter-metatarsophalangeal space

exercise regime
paracetamol

* endocrine: glucocorticoid excess (e.g. Cushing's, steroid therapy), hyperthyroidism, hypogonadism (e.g. Turner's, testosterone deficiency), growth hormone deficiency, hyperparathyroidism, diabetes mellitus
* multiple myeloma, lymphoma
* gastrointestinal problems: inflammatory bowel disease, malabsorption (e.g. Coeliacs), gastrectomy, liver disease
* rheumatoid arthritis
* long term heparin therapy*
* chronic renal failure
* osteogenesis imperfecta, homocystinuria
*research is ongoing as to whether warfarin is a risk factor

liver
kidney
seafood - oily fish
alcohol
yeast products