Al-Mehdi Gout

Question 1

more prevalent in men and most are asymptomatic for hyperuricemia

Answer 1

gout

Question 2

hyperuricemia leads to what

Answer 2

gout

Question 3

3 causes of hyperuricemia:

Answer 3

1. decrease in renal excretion of uric acid
2. increase in production from xanthine oxidase pathway
3. increase ingestion of purines

Question 4

examples of dietary purines

Answer 4

red meat, shellfish, beer

Question 5

a serum uric acid of >6.8 means what

Answer 5

gout

Question 6

these crystals deposit in joints to cause inflammation (gout)

Answer 6

monosodium urate (MSU)

Question 7

normal amount of uric acid filtered load that stays in urine

Answer 7

10%

Question 8

transporter for urate

Answer 8

urate transporter 1 (URAT1)

Question 9

reabsorption happens in what sections of proximal convoluted tubule

Answer 9

S1 and S3

Question 10

probenecid MoA

Answer 10

blocks URAT1 (inhibits reabsorption of urate, so increasing urate excretion)

Question 11

segment of proximal convoluted tubule that deals with urate secretion

Answer 11

S2

Question 12

role of NLRP3 inflammasome in pathogenesis of gout

Answer 12

activates caspase that ultimately produces IL-1beta (inflammatory)

Question 13

Anakinra and Rilonacept MoA

Answer 13

inhibit IL-1beta action

Question 14

stage of gout that deals with asymptomatic hyperuricemia

Answer 14

stage I

Question 15

stage of gout where there is an acute gouty flare and interval period gout

Answer 15

stage II

Question 16

stage of gout where there’s both gouty flares and tophi gout

Answer 16

stage III

Question 17

rapid onset and pain on first MTP usually; extreme tenderness; self-limiting

Answer 17

acute attack of gout

Question 18

joint swelling and tenderness

Answer 18

gouty arthritis

Question 19

monosodium urate deposition in fingers and ears

Answer 19

tophi

Question 20

signs of this include tophi in fingers, ears, and joints, and recurrent bouts of infection due to acute increase in uric acid

Answer 20

chronic gout

Question 21

tophi over PIP NOT DIP and also along ears and fingers

Answer 21

diagnose gout

Question 22

needle aspiration of joint fluid to diagnose gout:

Answer 22

negatively birefringent
blue when perpendicular
yellow when parallel

Question 23

urate crystal ingested by neutrophils sign of what

Answer 23

gout

Question 24

crystals over hyaline cartilage sign of what

Answer 24

gout

Question 25

2 complications of gout

Answer 25

uric acid kidney stones (nephrolithiasis) end stage renal disease

Question 26

what do you treat in acute gout

Answer 26

INFLAMMATION

Question 27

what do you treat in chronic gout

Answer 27

level of uric acid (want to reduce it)

Question 28

to treat acute gout:

Answer 28

NSAIDs, colchicine, glucocorticoids, anakinra

Question 29

drug to use for prophylaxis of gout attacks in interval (intercritical) period

Answer 29

colchicine

Question 30

microtubule disruptor – inhibits neutrophil migration) (first line for acute gout)

Answer 30

Colchicine

Question 31

to treat chronic gout

Answer 31

allopurinol, probenecid

Question 32

specific anti-inflammatory drug used to treat acute gout

Answer 32

Ibuprofen

Question 33

side effect of colchicine

Answer 33

diarrhea

Question 34

drug used to treat chronic gout that inhibits xanthine oxidase and has SE of hepatic/renal failure

Answer 34

Allopurinol

Question 35

drug used to treat chronic gout and inhibits xanthine oxidase and has cardiac SE

Answer 35

Febuxostat

Question 36

drug used to treat chronic gout and increases uric acid excretion by inhibiting URAT1 (so no reabsorption)

Answer 36

Probenecid

Question 37

best prophylaxis of gout

Answer 37

DIET

Question 38

x-linked recessive; mutation of HGPRT; self-mutilation and uric acid orange colored crystal in urine; gout

Answer 38

Lesch-Nyhan syndrome

Question 39

type of calcium pyrophosphate disease that has occasional inflammatory attacks in the knee

Answer 39

Pseudo-osteoarthritis

Question 40

type of calcium pyrophosphate disease that has onset not as abrupt as gout and attacks last longer; blood in joint fluid!!!!!; also mainly in knee

Answer 40

Pseudogout

Question 41

positively birefringent yellow when perpendicular blue when parallel

Answer 41

Pseudogout

Question 42

too much calcium in joint

Answer 42

CPPD (pseudogout)

Question 43

to treat acute CPPD

Answer 43

aspirate joint and inject glucocorticoids

Question 44

to treat chronic CPPD

Answer 44

prophylaxis (Colchicine)

Question 45

sites of apatite deposition for this disease includes knees and shoulders

Answer 45

calcium hydroxyapatite disease

Question 46

to treat calcium hydroxyapatite disease

Answer 46

NSAIDs and Colchicine

Question 47

diagnostic for what disease

Answer 47

calcium oxalate deposition disease

Question 48

autoimmune; pain in shoulder and hips; temporal arteritis (headaches) can lead to blindness

Answer 48

polymyalgia rheumatica

Question 49

to treat polymyalgia rheumatica

Answer 49

prednisone

Question 50

most common cause of musculoskeletal pain in women aged 20-55

Answer 50

fibromyalgia

Question 51

resembles neuropathic pain

Answer 51

fibromyalgia

Question 52

amplified pain perception seen in fibromyalgia

Answer 52

hyperalgesia

Question 53

pain brought on by nonpainful stimuli seen in fibromyalgia

Answer 53

allodynia

Question 54

duloxetine, venlaflaxine, pregabalin, and tramadol used to treat what

Answer 54

fibromyalgia

Question 55

If the ESR is above 100 mm/hr, what is the DDx?

Answer 55

temporal arteritis, polymyalgia rheumatica, osteomyelitis