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J MSK > Crystal arthropathies > Flashcards

Crystal arthropathies Flashcards

1
Q

if you suspect gout, what is the top differential

why

A

septic arthritis

presents similar but more serious

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2
Q

is gout more common in males or females

A

males (9:1)

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3
Q

what are the modifiable risk factors of gout (2)

A

diet - red meat, shellfish, cheese

alcohol

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4
Q

what is the general pathophysiology of gout

A

increase in urate acid crystals (hyperuricaemia)

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5
Q

aetiology of gout associated with over production of urate crystals (2 + examples)

A

genetics

high cell turnover - cancer, psoriasis, infection, excessive exercise

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6
Q

which skin condition is associated with gout

A

psoriasis

bc of high cell turnover

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7
Q

aetiology of gout associated with underexcretion of urate crystals (4)

A

thiazide diuretics
metabolic issues
renal failure!
starvation

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8
Q

in gout why are the urate crystals deposited in the joints

A

colder temp than other parts of body

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9
Q

in gout what happens when the crystals are deposited in the joints

A

inflammation of joint

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10
Q

what type of crystals are associated with gout

A

urate crystals

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11
Q

triggers for gout flare up (3)

A

dehydration
trauma
surgery

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12
Q

common locations of gout (3)

A

1st MTP joint (big toe)!!!!
ankle
knee

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13
Q

how many joints does gout usually involve

name of this

A

one

monoarthritic

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14
Q

presentation of gout (3)

when (2)

A 
red
hot 
severe pain 
rapid onset (hours/overnight)
lasts <2 weeks
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15
Q

investigations of gout (4)

A

joint aspiration
inflammatory markers
blood tests
blood cultures

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16
Q

what is the gold standard investigation for gout

A

joint aspiration

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17
Q

findings of joint aspiration of gout (2)

A

negative birefringent

needle shaped crystals

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18
Q

why do you need to do a blood test/culture for gout

A

to rule out septic arthritis

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19
Q

management of gout acute flare up (7)

A

expose, cool, elevate
antiinflammatory - NSAIDs, colchicine (if NSAID not tolerated), corticosteroids
analgesia

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20
Q

first line prophylaxis of gout flare up (after an acute attack)

A

allopurinol

21
Q

lifestyle modification for gout (4)

A

reduce red meat
reduce shellfish
reduce alcohol
loose weight

22
Q

what drug would you consider changing if someone was on it and had a gout acute attack

A

thiazide diuretics

23
Q

who do you give gout prophylaxis to

A

> 2 flare ups in 6 months

24
Q

does gout present on xray

A

acute attack - no

chronic gout - yes (erosions)

25
Q

when do you give gout prophylaxis (in relation to the attack)

A

2-4 weeks after acute attack (when flare up has settled)

26
Q

what is the mechanism of allopurinol

A

reduces uric acid production

27
Q

for gout do you start allopurinol for gout high dose or low dose

why

A

low dose

lowering uric acid too quickly can cause another acute gout attack

28
Q

what is an alternative uric acid lowering drug to allopurinol

A

febuxostat

29
Q

complications of gout

A 
chronic gout (polyarticular chronic joint inflammation) 
kidney stones
30
Q

how can gout result in kidney stones

A

urate crystals can be deposited in kidney tubules

31
Q

what is the differential list for someone with monoarthritic joint pain

A 
septic arthritis 
gout 
pseudogout 
enteropathic arthritis (IBD) 
reactive arthritis
32
Q

what type of crystals are deposited in pseudogout

A

calcium pyrophosphate crystals

33
Q

which group of people are more likely to get pseudogout

A

elderly

34
Q

which other MSK condition is pseudogout closely associated with

A

osteoarthritis

35
Q

which joints does pseudogout usually affect

A

knees
wrists
ankles

36
Q

gold standard investigations for pseudogout

A

joint aspiration

37
Q

result of joint aspiration in pseudogout (2)

A

positive birefringence

rectangular/rhomboid/envelope shaped crystals

38
Q

whats can differentiate between gout and pseudogout

A

joint aspiration

39
Q

is there inflammation in gout

A

yes

40
Q

is there inflammation in pseudogout

A

no

41
Q

treatment of pseudogout

A

NSAIDs
colchicine (if NSAIDs not tolerated)
steroids

42
Q

prophylaxis of pseudogout

A

none :(

43
Q

what is hydroxyapatite crystal deposition known as

A

Milwaukee shoulder

44
Q

where do hydroxyapatite crystals typically deposit

A

shoulder

45
Q

which group of people is Milwaukee shoulder common in

A

50-60 year old females

46
Q

investigations for Milwaukee shoulder

A 
alizarin stain (red clumps of calcium)
xray of shoulder (crystal deposits)
47
Q

presentation of Milwaukee shoulder

A

acute onset should pain

reduced range of movement

48
Q

renal failure

hot swollen joint

A

gout - decreased excretion of urate crystals

49
Q

rare complication of using allopurinol for gout

why

A

acute gout attack - bc it lowers the serum uric acid

J MSK (30 decks)

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