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Psychology- MHD > Clinical Approach- Joint Pain II > Flashcards

Clinical Approach- Joint Pain II Flashcards

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1
Q

What is crystal-induced arthropathy?

A

Crystals (like gout) deposit in your joints –> inflammation and pain

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2
Q

Does gout affect more males or females?

A

Males

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3
Q

High levels of ________ in the blood predisposes you to gout?

A

Uric acid ( > 6.8 mg/dL)

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4
Q

Food high in _____ can precipitate gout?

A

Purines

red meat, shellfish, beer and beans

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5
Q

Which diuretic increases risk of gout?

A

Thiazide diuretics

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6
Q

Describe the pathogenesis of gout

A

Supersaturation of uric acid –> crystal formation –> activates immune system –> increased IL-B1

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7
Q

Is hyperuricemia usually caused by overproduction or underexcretion of uric acid?

A

Underexcretion

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8
Q

Does everyone with hyperuricemia develop gout?

A

Only 20%

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9
Q

WHat are the two precursors for uric acid?

A

Adenine and Guanine (the two purines)

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10
Q

What is the pattern of onset of gout?

A

Acute “attacks” or “flairs” - usually monoarticular (but could be poly) that resolves in days to weeks

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11
Q

What is definitive diagnosis of gout?

A

Demonstration of crystal deposition on polarized microscopy (they are negative birefringent)

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12
Q

What are tophi?

A

Sheets/clumps of crystals in the joints

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13
Q

What are the go-to’s for treatment of and acute flair of gout?

A

NSAIDS, corticosteroids, anti IL-1

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14
Q

How do we prevent a relapse of gout?

A

Colchicine, NSAIDS

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15
Q

How do we decrease uric acid levels?

A

xanthine oxidase inhibitors

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16
Q

Pseudogout is the deposition of what crystals?

A

Calcium pyrophosphate dihydrate

17
Q

How does pseudogout present differently from gout?

A

Location of crystals- less podagra, knees and wrists are more involved

Inflammation is less severe

18
Q

What does chondrocalcinosis on x-ray imply?

A

Can be pseudogout, or could be asymptomatic

19
Q

Who gets pseudogout?

A

The eldery

20
Q

Is pseudogout a primary or secondary disease?

A

Can be either

Could be secondary to hemochromatosis, hyperparathyroidism, hypophosphatasia, or hypomagnesia

21
Q

Where does chondrocalcinosis most commonly appear?

A

Triangular cartilage of the wrist

22
Q

Contrast the appearance of gout vs CPPD/pseudogout

A

Crystals in pseudogout are smaller and harder to see

23
Q

Why are calcium phosphate crystals hard to see?

A

They don’t show up under polarized light?

24
Q

What is a “milwaukee shoulder?”

A

Hydroxyapatite associated destructive arthritis

Occurs in elderly females with destruction of the rotator cuff and glenohumeral joint

25
Q

What type of disorder is polymyalgia rheumatica?

A

Autoimmune disorder?

26
Q

How does polymyalgia rheumatica present?

A

Pain and stiffness in proximal joints and muscles –> shoulders and hips, neck muscles

27
Q

Name three markers of inflammation that are upregulated in polymyalgia rheumatica

A

IL-6, ESR and CRP

28
Q

What is the treatment for polymyalgia rheumatica?

A

Corticosteroids (prednisone)

Steroid sparing agents (methotrexate)

29
Q

What is the most common benign neoplasm of the synovium?

A

Tenosynovial Giant Cell Tumor

30
Q

Which joint is affected most by tenosynovial giant cell tumors?

A

Knee (80%)

31
Q

Which is a key finding to look for histologically for the diagnosis of tenosynovial giant cell tumor?

A

multiple hemosiderin-laden macrophages

+osteocyte

32
Q

What is the problem in tenosynovial giant cell tumors?

A

Overproliferation of cells in synovium

33
Q

What is the treatment for tenosynovial giant cell tumors

A

Surgical excision

34
Q

Are gout crystals needle shaped or rhomboid shaped?

A

Needle shaped

Psychology- MHD (14 decks)

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