Acute Urate Gout vs Chronic Tophaceous Gout

Question 1

Acute Urate Gout;

In almost all first attacks, a ? ? joint is affected.

Attacks may be precipitated by excess ?/? or ?.

It is generally self-limiting over 5-? days with a ? return to normality, although ? of the overlying skin is common.

Some patients describe ? episodes lasting just a few days.

Answer 1

single distal
food/alcohol
dehydration
14
complete
desquamation
milder

Question 2

AUG

Presentation;
o ? pain, often described as the ‘? ?’.
o ? onset of symptoms, often ? the patient.
o Maximum severity reached in 2-? hours.
o There is associated extreme ? (patient unable to wear a ?) and marked ? with ?.
o There may be accompanying ?, ? or ?.
–> • More common if a ? joint is affected.
o The joint will be held in the ‘? ?’ position.

Answer 2

severe
worst ever
rapid
waking
6
tenderness
sock
swelling
erythema
confusion
fever
malaise
large
loose pack

Question 3

AUG

It is possible that more than one joint can be affected, in ‘? attacks’.
o Activation of the ? ? response triggers more attacks.

The main differential diagnosis is ? ?;
o This is more subacute in onset, ? in severity until treated.
o ??? will be limited.
o Check for ? symptoms.

Answer 3

cluster
acute phase
septic arthritis
progressing
 ROM
systemic

Question 4

Chronic tophaceous gout;

Large MSUM ? deposits produce irregular firm nodules (‘?’ ) at
classical sites;
o ? surfaces of fingers, hands, ? and ? tendon.

This is associated with ? joint pain, and superimposed ? attacks.
The ? colour may allow distinction from ? nodules.

Answer 4

crystal
tophi
extensor
elbows
achilles
chronic
acute
white
rheumatoid

Question 5

CTG

Large nodules may ?, discharging white, ? material, associated with local ?.
They are generally a very ? feature, but may appear surprisingly rapidly in
patients with ? ? ?.

Answer 5

ulcerate
gritty
inflam
late
chronic renal failure