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Ch. 9 - Rheumatology > Crystal Arthropathies > Flashcards

Crystal Arthropathies Flashcards

1
Q

Define gout.

A
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2
Q

Describe the pathophysiology and causes of gout.

A
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3
Q

What is the most common site of gout.

A

1st MTP

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4
Q

What is the gender distribution of gout?

A
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5
Q

What is metabolic syndrome and its features?

A
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6
Q

What are the RFs for gout.

A
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7
Q

How can gout present?

A

+ non-painful tophi - ears, along articular surfaces, elbow, bursa

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8
Q

Define pseudogout.

A
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9
Q

Describe the pathophysiology of pseudogout.

A
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10
Q

What are the RFs for pseudogout?

A
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11
Q

What are the symptoms of gout?

A
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12
Q

Pseudogout has a more similar presentation to OA/RA than gout. Why?

A
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13
Q

What are the ddx for gout/ pseudogout?

A

same as OA ddx (shown in image)

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14
Q

What is crowned dens syndrome? What will be shown on CT?

A
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15
Q

What are the exam finding for gout and pseudogout

A

TOPHI ONLY IN GOUT!!

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16
Q

How would you diagnose gout?

A
17
Q

How would you diagnose pseudogout?

A

Clinical dx and synovial fluid analysis.

18
Q

Differentiate between gout and pseudogout on synovial fluid analysis.

A
19
Q

Differentiate between gout and pseudogout on xray.

A
20
Q

Describe this image. What is your dx?

A

U/S showing double contour sign overlying the joint cartilage (seen only in gout)

21
Q

What are the investigations to find the etiology of pseudogout?

A
22
Q

You are investigating a patient with an expected

A
23
Q

What are your supportive investigations for pseudogout? How would the results differ in gout vs pseudogout?

A
24
Q

What are your supportive investigations for gout? How would the results differ in gout vs pseudogout?

A
25
Q

What is the medical management of an acute flare up of gout? Include dose and route of administration.

A
26
Q

Outline the conservative/ lifestyle management of gout.

A
27
Q

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?

A
28
Q

What is the long term pharmacological management of gout?

A

Urate lowering therapy - allopurinol, febuxostat

Uricosuric agents - probenecid, benzbromarone

29
Q

What is the MOA and SEs of allopurinol? When disease, if co-occurring warrants caution when giving allopurinol and may require a dose reduction?

A
30
Q

When disease, if co-occurring warrants caution when giving febuxostat? What is the MOA of this drug?

A

HF
xanthine oxidase inhibitor

31
Q

What is the MOA of
1. probenecid
2. benzbromarone

A

both increase uric acid exretion

32
Q

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?

A

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)

33
Q

What is the MOA of rasburicase?

A

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.

34
Q

Outline the full management of a patient who presents with gout?

A
35
Q

What are the complications of gout?

A
36
Q

Outline the acute management of pseudogout.

A
37
Q

Outline the chronic management of pseudogout.

A
38
Q

Outline the FULL management of pseudogout.

A

Ch. 9 - Rheumatology (11 decks)

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