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Rheumatology > 365 Gout > Flashcards

365 Gout Flashcards

1
Q

results from increased body pool of urate with hyperuricemia

A

gout

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2
Q

characteristic of gout

A

deposition of MSU crystals in joints, connective tissue, and the risk for development for deposition in kidney interstitium or uric acid nephrolithiasis

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3
Q

most common early manifestation of gout

A

acute arthritis

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4
Q

often involved in gout

A

metatarsophalangeal joint of the first toe

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5
Q

first manifestations of gout

A

inflammed Heberdens or Bouchards nodes

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6
Q

True or false. Most women with gouty arthritis are postmenopausal and elderly

A

True.

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7
Q

Common comorbidities of women with gout

A

osteoarthritis, arterial hypertension and mild renal insufficiency

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8
Q

True or false. Serum uric acid can be normal or low at the time of an acute attack

A

True.

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9
Q

confirmed diagnosis of gout

A

needle aspiration of MSU crystals

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10
Q

suggest overproduction of purine

A

excretion of more than 800 mg of uric acid in 24 hr on regular diet

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11
Q

characteristic radiographic features of chronic tophaceous gout

A

cystic changes, well defined erosions with sclerotic margins and soft tissue mass

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12
Q

early sign on ultrasound to point out gout

A

double contour sign overlying the articular cartilage

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13
Q

how is colchicine given

A

0.6 mg every 8 hrs with subsequent tapering or 1.2 mg followed by 0.6 mg in 1 hr with subsequent day dosing depending on response

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14
Q

how is prednisone given in patient with gout

A

Prednisone 30-50 mg/d

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15
Q

Target serum uric acid

A

less than 300-360 ummol/L or 5.0-6.0 mg/dl

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16
Q

given to patients who underexcrete uric acid

A

Probenecid 250 mg BID max of 3 g per day

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17
Q

creatinine level when probenecid is not effective

A

creatinine more than 2 mg/dl or more than 177 mmol/L

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18
Q

best drug to lower serum urate in overproducers

A

allopurinol

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19
Q

hypouricemic therapy given to patients with CKD

A

allopurinol or febuxostat

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20
Q

Dose of allopurinol in CKD

A

100 mg daily

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21
Q

toxicity of allopurinol is recognized in patients who

A

use thiazide diuretics, allergic to penicillin and ampicillin and in Asians with HLA-B*58:01

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22
Q

most serious side effect of allopurinol

A

toxic epidermal necrolysis

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23
Q

peglyated uricase available for patietns who do not tolerate or fail full doses of other treatments

A

pegloticase

24
Q

True or false. Urate lowering drugs are generally not initiated during acute attacks

A

True.

25
Q

prophylaxis dose of colchicine

A

0.6 mg daily or BID until patient is normouricemia and without gouty attacks for 6 months or as long as tophi are present

26
Q

Can patients with tophi discontinue colchicine

A

no

27
Q

True or false. Clarithromycin can increase toxicity of colchicine

A

True.

28
Q

precipitants of acute attacks

A

dietary excess, trauma, surgery, excessive ethanol ingestion, hypouricemic therapy, serious illness

29
Q

stages of classic gout

A

asymptomatic, acuter intermittent gout, chronic tophaceous gout

30
Q

characteristic imaging of gout on dual energy CT

A

establish presence of urate crystals

31
Q

differential diagnoses of gout

A

acute septic arthritis, crystal associated arthropathies, palindromic rheumatism, psoriatic arthritis

32
Q

synovial fluid character of gout

A

needle shaped monosodium urate crystal seen; on compensated polarized light: crystals are brightly refringement with negative elongation

33
Q

most affected joint in CPPD arthropathy

A

knee

34
Q

definitive diagnosis of CPPD

A

demonstration of typical rhomboid or rodlike crystals weakly positive birefringment or nonbirefringement with polarized light in synovial fluid

35
Q

True or false. There is still no effective way to remove CPP deposits from cartilage and synovium

A

True.

36
Q

treatment of CPPD

A

rest, joint aspiration, NSAIDs, intraarticular glucocorticoid injection

37
Q

IL B antagonist that may be given in patients with severe CPPD

A

anakinra

38
Q

primary mineral of normal bone and teeth

A

apatite

39
Q

where does apatite usually occur

A

in the shoulder

40
Q

True or false. Apatite aggregates are commonly present in the synovial fluid in an extremely drestructive chronic arthropathy of the elderly

A

True.

41
Q

Radiograph of apatite arthritis

A

intra and or periarticular calcifications with or without erosive destructive or hypertrophic changes seen on radiograph

42
Q

definitive diagnosis of apatite arthritis

A

clumps of 1 to 20 um shiny intra or extracellular nonbirefringement globules or aggregates that stain purple with Wrights and bright red with alizarin red S. tetracycline binding

43
Q

other name or apatite arthritis

A

basic calcium phosphate disease

44
Q

True or false. CaOx arthritis features may not be indistinguishable from those due to urate, CPP or apatite

A

True,

45
Q

Synovial fluid finding of CaOx arthritis

A

bipyramidal and small polymorphic calcium oxalate crystals

46
Q

Gold standard in diagnosis of gout

A

Arthrocentesis

47
Q

Useful tets for the screening for risk for nephrolithiasis

A

24h urine uric acid

48
Q

Utz finding of gout

A

Hyperechoic spots under 1 mm and demonstrate posterior shadowing (snow storm appearance)

49
Q

How long to give colchicine

A

7-10 days until flares resolve

50
Q

True or false. Short course Steroid use can lead to rebound flares

A

True

51
Q

How to give allopurinol in gout

A

100-800 mg per day until SUA less than 6 mg/dl

52
Q

What’s the dosing for allopurinol in CKD 4

A

50 mg/day and escalation should be slower

53
Q

How to give febuxostat

A

20 mg then 40 mg to max of 80 mg per day

54
Q

How to give pegloticase

A

8 mg per infusion every 2 weeks or 250 g BID increasing until 3 grams per day

55
Q

Differential in monoarthritis

A

Septic arthritis

56
Q

True or false. Febuxostat has associated cardiovascular thrombotic side effect. What trial?

A

True. CARES trial

Rheumatology (15 decks)

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