Crystal Arthropathies Flashcards
Define gout.
Describe the pathophysiology and causes of gout.
What is the most common site of gout.
1st MTP
What is the gender distribution of gout?
What is metabolic syndrome and its features?
What are the RFs for gout.
How can gout present?
+ non-painful tophi - ears, along articular surfaces, elbow, bursa
Define pseudogout.
Describe the pathophysiology of pseudogout.
What are the RFs for pseudogout?
What are the symptoms of gout?
Pseudogout has a more similar presentation to OA/RA than gout. Why?
What are the ddx for gout/ pseudogout?
same as OA ddx (shown in image)
What is crowned dens syndrome? What will be shown on CT?
What are the exam finding for gout and pseudogout
TOPHI ONLY IN GOUT!!
How would you diagnose gout?
How would you diagnose pseudogout?
Clinical dx and synovial fluid analysis.
Differentiate between gout and pseudogout on synovial fluid analysis.
Differentiate between gout and pseudogout on xray.
Describe this image. What is your dx?
U/S showing double contour sign overlying the joint cartilage (seen only in gout)
What are the investigations to find the etiology of pseudogout?
You are investigating a patient with an expected
What are your supportive investigations for pseudogout? How would the results differ in gout vs pseudogout?
What are your supportive investigations for gout? How would the results differ in gout vs pseudogout?
What is the medical management of an acute flare up of gout? Include dose and route of administration.
Outline the conservative/ lifestyle management of gout.
A patient was treated with colchicine for an acute flare up for his gout. When should he be reviewed next?
After that review, when again would you follow up the patient?
What is the long term pharmacological management of gout?
Urate lowering therapy - allopurinol, febuxostat
Uricosuric agents - probenecid, benzbromarone
What is the MOA and SEs of allopurinol? When disease, if co-occurring warrants caution when giving allopurinol and may require a dose reduction?
When disease, if co-occurring warrants caution when giving febuxostat? What is the MOA of this drug?
HF
xanthine oxidase inhibitor
What is the MOA of
1. probenecid
2. benzbromarone
both increase uric acid exretion
A male patient (68 yoa) presents to the ED with confusion, muscle weakness, n+v, palpitations, numbness and tingling around the mouth, flank pain and reduced urine output.
Medical history of note - He was recently diagnosed with Diffuse Large B-Cell Lymphoma and is currently receiving R-CHOP regimen. (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, Prednisone).
On exam -
You notice a suspected gout lesion on his 1st MTP.
Tapping the facial nerve (in front of the ear) causes twitching of facial muscles.
Inflating a blood pressure cuff above systolic pressure for 3 minutes induces carpal spasm (wrist flexion, thumb adduction, and finger extension).
How would you manage his gout? How would you prevent this from reoccurring?
This patient has gout secondary to tumour lysis syndrome.
Same acute management as any gout- colchicine
Long-term - allopurinol or rasburicase should be given prior to chemo.
Hyperkalemia - confusion, muscle weakness, n+v, palpitations,
Hypocalcemia - numbness and tingling around the mouth, flank pain and reduced urine output (secondary to hyperphosphatemia)
On exam -
You notice a suspected gout lesion on his 1st MTP.
Tapping the facial nerve (in front of the ear) causes twitching of facial muscles. (hypocal)
Inflating a blood pressure cuff above systolic pressure for 3 minutes induces carpal spasm (wrist flexion, thumb adduction, and finger extension). (hypocal)
What is the MOA of rasburicase?
Rasburicase is a recombinant urate oxidase enzyme used to rapidly reduce uric acid levels. It converts uric acid into allantoin, which is more soluble and easily excreted.
Outline the full management of a patient who presents with gout?
What are the complications of gout?
Outline the acute management of pseudogout.
Outline the chronic management of pseudogout.
Outline the FULL management of pseudogout.
