PBL Sessions: Musculoskeletal Organ System

Page 6

History of Present Illness:

The allopurinol is stopped, and he is started on probenecid. A month later his serum uric acid is 6.8 mg/dL.

An oral glucose tolerance test is performed, with the following results:

The patient's pain in the toe diminishes, but the aches and pains in other joints continues. He states that he is feeling more fatigued in the last couple of months. He notes that at the end of the day his ankles are swollen, and when he takes his shoes off for a while they are hard to put back on. He relates that he seems to have less body hair now, and he seems to have increased breast size. A friend of his who he had not seen for several years remarked that he had a "funny color" to his skin. Your re-examination of his skin confirms this finding, and you note the change in colour is particularly marked in his old appendectomy scar and on his face.

Figure 6: Representation of skin hue

Tasks

• What do these findings indicate?

• What hypotheses explain these findings?

• Explain your reasoning for the hypotheses you choose.

• Is there anything that can tie these findings together?

• What laboratory test(s) could you order on this patient?

Stop !! Complete discussions and tasks before moving to the next page.