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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

25
prophylaxis dose of colchicine
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
Can patients with tophi discontinue colchicine
no
27
True or false. Clarithromycin can increase toxicity of colchicine
True.
28
precipitants of acute attacks
dietary excess, trauma, surgery, excessive ethanol ingestion, hypouricemic therapy, serious illness
29
stages of classic gout
asymptomatic, acuter intermittent gout, chronic tophaceous gout
30
characteristic imaging of gout on dual energy CT
establish presence of urate crystals
31
differential diagnoses of gout
acute septic arthritis, crystal associated arthropathies, palindromic rheumatism, psoriatic arthritis
32
synovial fluid character of gout
needle shaped monosodium urate crystal seen; on compensated polarized light: crystals are brightly refringement with negative elongation
33
most affected joint in CPPD arthropathy
knee
34
definitive diagnosis of CPPD
demonstration of typical rhomboid or rodlike crystals weakly positive birefringment or nonbirefringement with polarized light in synovial fluid
35
True or false. There is still no effective way to remove CPP deposits from cartilage and synovium
True.
36
treatment of CPPD
rest, joint aspiration, NSAIDs, intraarticular glucocorticoid injection
37
IL B antagonist that may be given in patients with severe CPPD
anakinra
38
primary mineral of normal bone and teeth
apatite
39
where does apatite usually occur
in the shoulder
40
True or false. Apatite aggregates are commonly present in the synovial fluid in an extremely drestructive chronic arthropathy of the elderly
True.
41
Radiograph of apatite arthritis
intra and or periarticular calcifications with or without erosive destructive or hypertrophic changes seen on radiograph
42
definitive diagnosis of apatite arthritis
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
other name or apatite arthritis
basic calcium phosphate disease
44
True or false. CaOx arthritis features may not be indistinguishable from those due to urate, CPP or apatite
True,
45
Synovial fluid finding of CaOx arthritis
bipyramidal and small polymorphic calcium oxalate crystals
46
Gold standard in diagnosis of gout
Arthrocentesis
47
Useful tets for the screening for risk for nephrolithiasis
24h urine uric acid
48
Utz finding of gout
Hyperechoic spots under 1 mm and demonstrate posterior shadowing (snow storm appearance)
49
How long to give colchicine
7-10 days until flares resolve
50
True or false. Short course Steroid use can lead to rebound flares
True
51
How to give allopurinol in gout
100-800 mg per day until SUA less than 6 mg/dl
52
What's the dosing for allopurinol in CKD 4
50 mg/day and escalation should be slower
53
How to give febuxostat
20 mg then 40 mg to max of 80 mg per day
54
How to give pegloticase
8 mg per infusion every 2 weeks or 250 g BID increasing until 3 grams per day
55
Differential in monoarthritis
Septic arthritis
56
True or false. Febuxostat has associated cardiovascular thrombotic side effect. What trial?
True. CARES trial

Rheumatology (15 decks)

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