While performing a physical assessment of a male client with gout of the great toe, Nurse Vivian should assess for additional tophi (urate deposits) on the:
A. Buttocks
B. Ears
C. Face
D. Abdomen
Correct Answer: B. Ears
Uric acid has a low solubility, it tends to precipitate and form deposits at various sites where blood flow is least active, including cartilaginous tissue such as the ears. Tophi, which are subcutaneous depositions of urate that form nodules, can also be found in patients with persistent hyperuricemia. Tophi typically occur in the joints, ears, finger pads, tendons, and bursae.
Option A: The buttocks are incredibly vascular areas making it a rare location for the growth of tophi. In a patient who is having a gout flare-up, the symptoms are often apparent. The most commonly involved joint is the first metatarsophalangeal joint. The talar, subtalar, ankle, and knee can also be involved in some cases.
Option C: Tophi rarely grow on the face; they are found most commonly on the fingers, toes, wrists, and ears. Although affliction of the joints mentioned above is common in gout, the physician should pay attention to other joints, specifically those joints with underlying osteoarthritis. Besides joints, other periarticular structures such as tendons and bursa may also be affected.
Option D: The abdomen is not a location for tophi growth because it occurs most commonly in least vascular areas or in joints. The physical exam findings align with the patient history. The affected joint is typically red, swollen, warm, and tender. In patients with chronic gout, the flare-up may involve multiple joints. With the involvement of many joints, it can cause a systemic inflammatory response syndrome that may masquerade as sepsis.