Chempath 1: Hyperuricaemia and gout

Question 1

Name the classical sign when Gout affects the 1st metatarsophalangeal joint ?

Answer 1

Podagra

Question 2

Describe the shape of Urate crystals in gout ?

Answer 2

Needle

Question 3

Describe the shape of Calcium pyrophosphate crystals in Pseudo gout?

Answer 3

Rhomboid

Question 4

Are gout crystals negatively or positively birefringent in polarised light ?

Answer 4

Negatively

Question 5

Are Pseudogout crystals negatively or positively birefringent in polarised light ?

Answer 5

Positively

Question 6

What is the acute treatment for gout ?

Answer 6

Colchicine

Question 7

What is the long term treatment for gout ?

Answer 7

Allopurinol

Question 8

Which anti-diuretics can precipitate gout attacks ?

Answer 8

Thiazide diuretics

Question 9

List 3 precipitants for gout attacks ?

Answer 9

Alcohol
Thiazide diuretics
Chemotherapy

Question 10

Which enzyme is the rate limiting step in de novo purine metabolism ?

Answer 10

PAT

Question 11

In which body tissue does the de Novo pathway predominate as the main pathway for purine synthesis ?

Answer 11

Bone marrow

High requirement for purines in bone marrow, so uses the De Novo pathway even though it is less efficient

Question 12

List some of the features of Lesch-Nyhan syndrome ?

Answer 12

• Inborn error of purine metabolism
• HGPRT deficiency means they cant use salvage pathway
• X-linked disease
• Gout in child
• Choreiform movements
• Mental retardation
• self mutilation (biting thumb/lip very hard)

Question 13

Which enzyme is the rate limiting step in the salvage pathway?

Answer 13

-HGPRT

Question 14

List 4 causes of decreased Urate excretion ?

Answer 14

• Lead poisoning
• Thiazide diuretics
• Barterr’s syndrome
• Aspirin

(renal failure)

Question 15

Which drug must never be given with Allopurinol ?

Answer 15

Azathioprine

causes increased bone marrow toxicity