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JG Year 1 > 137 Gout > Flashcards

137 Gout Flashcards

1
Q

Name some types of non-inflammatory arthritis

A

OA
Neuropathic
Osteochondritis dissecans

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2
Q

Name 4 types of inflammatory arthritis

A

RA
Gout
Juvenile Chronic arthritis
Psoriatic arthritis

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3
Q

What are the signs and symptoms of monoarthritis?

A

Pain
Swelling of joint
Erythema of overlying skin
Decreased range of movement

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4
Q

Which organism is the most likely cause of septic arthritis?

A

Staph aureus

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5
Q

What is not present in the serum of sero-negative arthritis and which surface antigen is present?

A

Rheumatoid factor = not

HLA-B27

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6
Q

Which joints are affected mostly in psoriatic arthritis

A

Smaller joints ie distal interphalangeal joints

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7
Q

What can be seen on xray in psoriatic arthritis?

A

Erosion of the central joint

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8
Q

What is used to treat severe psoriatic arthritis?

A

Methotrexate
Ciclosporin
anti TNF-alpha agents

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9
Q

Which drugs should be avoided when treating psoriatic arthritis?

A

NSAIDs - could exacerbate the skin lesions

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10
Q

Which 2 groups of patients are most likely to develop haemoarthrosis?

A

Haemophiliacs

Warfarin users

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11
Q

Which crystals form in pseudogout and where do they usually accumulate?

A

pyrophosphate crystals –> in the knees

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12
Q

What is the treatment of pseudogout?

A

analgesia
steroid injection
joint replacement

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13
Q

Name some predisposing factors for septic arthritis?

A 
prosthetic joint
immunosuppression
elderly
DM
RA
existing joint damage
IV drugs
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14
Q

What are the risks of leaving septic arthritis untreated?

A

Rapid joint destruction
Sinus/abscess formation
Septicaemia
Death

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15
Q

Name the 4 things observed on an x-ray of a septic arthritic joint

A
  1. Loss of joint space
  2. Subchondral bone erosion
  3. Sclerosis of femoral head
  4. Osteonecrosis/collapse of femoral head
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16
Q

What investigations are needed to diagnose septic arthritis?

A

MC&S of the aspirate
Blood cultures
CRP

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17
Q

What is the antibiotic of choice for the treatment of septic arthritis? Duration?

A

IV Flucloxacillin 1 - 2g + fusidic acid

IV 2/52 , followed by 4/52 PO

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18
Q

Should the joint be immobilised/mobilised following washout of septic arthritis?

A

Immobilised

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19
Q

What is gout?

A

Inflammatory response to monosodium urate monohydrate crystals in hyperuricaemia

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20
Q

Which enzyme is deficient in gout and which synthesis pathway does this occur in?

A

Urate oxidase in purine synthesis

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21
Q

Which group are most likely to develop gout?

A

Middle aged men

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22
Q

What effects do high and low dose aspirin have on the excretion of urate?

A 
High = increases excretion
Low = decreases excretion
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23
Q

What effect can renal impairment have on the excretion of urate?

A

Reduced excretion

24
Q

What investigations should be performed when suspecting gout?

A 
Joint fluid microscopy
Serum urate (>600 = raised)
U&EC
CRP
Urinalysis
25
Q

What other factors would influence you giving urate reducing agents like allopurinol in a primary acute gout?

A 
Other comorbidities
Complications associated with the acute gout 
Impaired renal function
Frequency
Age
26
Q

When should gout patients be given urate reducing agents?

A

Post 2nd attack
Renal impairment/stones
Tophi/tissue damage

27
Q

When should urate reducing agents not be given to gout pts? What should be given in the meantime?

A

During an acute attack + 1 month after

Should give NSAIDs 4/52 prior to allopurinol

28
Q

Name 2 xanthine oxidase inhibitors

A

Allopurinol

Feboxustat

29
Q

Which 2 drugs does allopurinol interact with?

A

Warfarin

Azathiopine

30
Q

Which class of drugs are sulphinpyrazone, probenecid and benzobromarone?

A

Uricosuric agents

31
Q

What is the MOA of uricosuric agents?

A

Increase excretion of uric acid - inhibits resorption of UA at the proximal convoluted tubule

32
Q

What is the main function of calcium homeostasis?

A

To maintain serum calcium levels

33
Q

Why is calcium important in the body? (7 listed)

A

Formation of calcified tissues
Normal nerve and muscle activity
NT release, hormonal and glandular secretion
Excitation coupling of cardiac and SM
Integrity and permeability of cell membranes
Cell adhesion
Blood clotting

34
Q

What converts 7-dehydroxy cholesterol into vitamin D3 and where does this occur?

A

UV light in the skin

35
Q

Which enzyme involved with vitamin D synthesis is stimulated by PTH?

A

1 alpha- hydroxylase

36
Q

What is the effect of viatmin D3 in the intestines?

A

Increases Ca absorption by stimulating espression of Ca2+ transport proteins

37
Q

What is the effects of vitaminD3 on bone mineralisation?

A

Increases bone mineralisation by inducing terminal differentiation of osteoclasts and increasing serum calcium directly via osteoblasts

38
Q

Name 3 ways in which VitD3 affects a tumour microenvironment

A
  1. inhibits - proliferation
  2. inhibits angiogenesis
  3. Induces differentiation
39
Q

Which cells produce PTH?

A

Chief cells of the parathyroid glands

40
Q

Name 3 ways in which PTH increases serum calcium

A

Stimulates bone resorption
Increases tubular resorption in kidneys
Stimulates 1alpha hydroxylase to hydroxylate Vit D3

41
Q

Which hormone is synthesised in the parafollicular cells of the thyroid?

A

Calcitonin

42
Q

What are the main functions of calcitonin?

A

Vit D regulation
Inhibits bone resorption
Satiety

43
Q

What is the main cause of hypercalcaemia?

A

Primary hyperparathyroidism

44
Q

What is the main cause of hypocalcaemia?

A

Renal failure

45
Q

What is the gross effect of hypercalcaemia on the body?

A

Causes supression of activity as it blocks sodium channels

46
Q

What are the effects of hypercalcaemia on the CNS?

5 listed

A 
Depression
Lethargy
Decreased alertness
Confusion
Coma
47
Q

What are the effects of Hypercalcaemia on the GIT?

3 listed

A

Anorexia
Constipation
N&V

48
Q

Why are there more #s in hypercalcaemia?

A

Increased bone resorption (see Ca2+ homeastasis)

49
Q

What is the gross effect of hypocalcaemia on the body?

A

Mainly causes increased activity as lowers threshold for depolarisation

50
Q

What is Trousseu’s sign?

A

Inflate BP to systolic pressure and after 3 mins, fingers and wrist will spasm tetanically

51
Q

What is Chvostek’s sign?

A

Tap on CN VII –> twitching of facial muscles on ipsilateral side

52
Q

What is pseudohypoparathyroidism?

A

Individual is resistant to PTH so high PTH levels in serum.

53
Q

Why is an osteochondral lesion ‘better’ than a chondral lesion?

A

Better healing as bleeding is stimulated of the underlying subchondral bone –>chondroprogenitor cells induce the healing

54
Q

What is the Tx for advanced OA of the knee?

A

TKR

55
Q

Which 2 enzymes are used in the culture expansion of autologous chondrocytes in ACI?

A

Collagenase and pronase

56
Q

Which antibiotic is added to the culture medium in ACI?

A

Gentamycin

57
Q

What is used in MACI as a scaffold?

A

Porcine collagen

JG Year 1 (27 decks)

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