bennett

Question 1

define goat

Answer 1

An acute arthritic process, which develops from the accumulation of uric acid

Question 2

general characteristics of goat pts

Answer 2

• usually affect men older than 25 and women who are post-menopausal
• initial presentaiton is usually a PAINFUL ATTACK of monoarticular arthritis
• Various precipitating factors (trauma, alcohol, surgery, diet, and drugs)

Question 3

primary vs secondary gout

Answer 3

• Primary
  
  • inherited as idiopathic or secondary to a defect in purine metabolism leading to overproduction of uric acid
• Secondary
  
  • result of an inherited disorder or the result of over production due to increase of cellular turnover, or in under secretion

Question 4

differentials of goat

Answer 4

• crystal arthropathies
• infection –> cellulitis or osteomialitis
• sarcoidosis
• trauma
• SEPTIC JOINT
• fracture
• osteoarthritis
• pseudogout –> inflammation isnt as intense

Question 5

symptoms of goat

Answer 5

• pain of the involved joint
• redness
• swelling
• mild fever and chills

Question 6

4 phases of gout

Answer 6

• asymptomatic hyperuricemia –> high levels of uric acid in system
• Acute gouty Arthritis
  
  • most pts; hot, painful joint (days or week)
• intercritical gout
  
  • one attack with a sustained high level of uric acid
• chronic tophaceous gout
  
  • high sustained uric acid levels with accumulation of uric acid in different parts of the body

Question 7

criteria for the daignosis of acute gout

Answer 7

• maximum inflammation developed within ONE DAY
• more than one attack of acute arthritis
• presents with monoarticular arthritis
• redness is observed over affected joint
• first metatarsophalangeal pain or swelling
• unilateral first metatarsophalangeal joint attack
• unilateral tarsal joint attack
• tophus is sustemected
• HYPERuricemia
• asymmetric swelling within a joint
• subcortical cysts without erosision in radiograph
• joint fluid culture negative for organism

Question 8

Describe the work up for gout

Answer 8

• Blood work
  
  • Serum uric acid level = 3-7 mg/dl (normal)
    
    • when they have an acute flare up the uric levels may be NORMAL
• Joint aspiration - synovial fluid analysis
  
  • thick straw colored fluid (normal)
  • glocose elvel
  • WBC should not be present
  • • septic joint will have WBC present

Question 9

Why the 1st MPJ?

Answer 9

• An INCREASE in URIC ACID WILL DECREASE the SOLUBILITY resulting in crystal formation
  
  • trauma or walking initiates a low grade inflammation resulting in lower pH
  • decrease in temp of toe
  • cooling of the extremities and decrease heart rate while sleeping

Question 10

TX of acute gout

Answer 10

• NSAID –> reduces inflammation
• Colchicine –> reduces inflammation
• Corticosteroids –> reduces inflammation
• analgesics

Question 11

long term management of gout

Answer 11

• allopurinol –> blocks formation of uric acid
• febuxostat
• probenecid –> increases excretion of uric acid in urine
• sulfinpyrazone

Question 12

Which foods are high in purine content

Answer 12

• bacon
• fish: anchovies, codfish, herring, salmon, sardines, trought
• kidneys
• liver
• shellfish
• veal
• venison
• turkey

Question 13

causes of sustained hyperuricemia

Answer 13

• ACQUIRED
• alcohol consumption
• exercise
• fructose consumption
• high purine intake
• myeloproliferative disorders
• obesity and hypertriglyceridemia

Question 14

Uric acid lithiasis

Answer 14

• development of stone or calculus composed of urate precipitate within the bladder, ureter or renal pelvis
• conc of uric acid in urine exceeds its solubility at the urine pH, uric acid chagnes from a compound dissolved insolution to insoluble precipitate
• URATE STONES FORMED BY:
  
  • overproduction
  • increased tubular secretion
  • decreased tubular reabsorption
• WORK UP = 24 hour urinalysis, CT scan, urine chem
• TX = HYDRATION