Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

A. MLA Map General Practice and Primary Healthcare > Crystal Arthroplasty - Gout/Pseudogout > Flashcards

Crystal Arthroplasty - Gout/Pseudogout Flashcards

1
Q

Arthropathy is a pathological disease of a joint.

Arthro = joint
pathy = pathological disease

What is the most common inflammatory arthropathy worldwide?

1 - lupus
2 - RA
3 - osteoarthritis
4 - gout

A

4 - gout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the incidence of gout in UK adults?

1 - 2.5%
2 - 10%
3 - 20%
4 - 50%

A

1 - 2.5%
- most commonest cause of inflammatory arthritis
- this is increasing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Does gout affect men or women more?

A
  • men
  • 5:1 ratio
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the mean age onset in men for gout?

1 - 25
2 - 35
3 - 45
4 - 60

A

3 - 45

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is the mean age onset in women for gout?

1 - 25
2 - 35
3 - 45
4 - 60

A

4 - 60

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Which of the following is NOT a non-modifiable risk factors for gout?

1 - Age
2 - Male Sex
3 - Family History
4 - Race
5 - Weight

A

5 - Weight

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Which of the following is NOT a known risk factors for gout?

1 - diabetes
2 - hypertension
3 - renal impairment
4 - contraception use
5 - hypertension
6 - alcohol use

A

4 - contraception use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Which of the following is NOT a common modifiable risk factors for gout?

1 - BMI
2 - gender
3 - beer
4 - meat

A

2 - gender

  • BMI - Relative Risk (RR) 3
  • Beer - RR 2.5
  • Meat - RR 1.5
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Arthropathy is a pathological disease of a joint. The most common inflammatory arthropathy worldwide is gout, which is caused by the formation and build up of what?

1 - antibody complexes in the joints
2 - hyaluronic acid
3 - uric acid
4 - acetic acid

A

3 - uric acid

Caused by either:
- too much uric acid production
- lack of clearance by the kidneys

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Arthropathy is a pathological disease of a joint. The most common inflammatory arthropathy worldwide is gout, which is caused by the formation and build up of uric acid. Where does uric acid in the body come from?

1 - consumed in the diet
2 - waste product produced by the liver
3 - breakdown product of purines found in DNA
4 - medication metabolite

A

3 - breakdown product of purines found in DNA

  • natural process as they are removed from the body via the kidneys in urine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Arthropathy is a pathological disease of a joint. The most common inflammatory arthropathy worldwide is gout, which is caused by the formation and build up of uric acid, which is from the breakdown of purines which are found in DNA throughout the body, which is then removed via the kidneys as urine. This uric acid is not very soluble and when levels of uric acid become too high this is called what?

1 - hyponatraemia
2 - hypouricaemia
3 - hypernatraemia
4 - hyperuricaemia

A

4 - hyperuricaemia
- saturation point is around 408 μmol/L but diagnosis >500

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Monosodium urate is what causes gout and the build of this goes on to form monosodium urate crystals in joints. How is monosodium urate formed?

1 - uric acid gains proton at pH 7.4, extra proton binds K+
2 - uric acid gains proton at pH 7.4, extra proton binds Na+
3 - uric acid loses proton at pH 7.4, extra proton binds Na+
4 - uric acid loses proton at pH 7.4, extra proton binds K+

A

3 - uric acid loses proton at pH 7.4, extra proton binds Na+

  • urate ion binds 1 Na+, becoming monosodium urate
  • uric acid becomes urate and 1 Na+ gives the monosodium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Monosodium urate forms from the breakdown of purines into uric acid, which then goes on to form monosodium urate crystals. Where do these monosodium urate crystals generally get deposited in the body?

1 - good blood flow and warm
2 - good blood flow and cold
3 - poor blood flow and warm
4 - poor blood flow and cold

A

4 - poor blood flow and cold

  • peripheral tissues and joints (feet and hands)
  • cartilage and periarticular (outside of joints)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

There are a number of different types of gout. What does podgra relate to in gout?

1 - greek for hand trap
2 - greek for knee
3 - greek for foot trap
4 - greek for elbow

A

3 - greek for foot trap

  • think P for podgra and pedalis
  • relates to gout affecting the foot at the metatarsophalangeal joint of great toe
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

70% of patients who get gout will get podagra. Which joint does this occur in?

1 - 1st metacarpophalangeal joint
2 - 2nd metatarsophalangeal joint
3 - 1st metatarsophalangeal joint
4 - talotibial joint

A

3 - 1st metatarsophalangeal joint
- this is typically a clinical diagnosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

In a first gout attack, the 1st metatarsophalangeal joint is commonly affected. However, in subsequent attacks is the same joint affected or does it become polyarticular?

A
  • polyarticular
  • affects multiple joints
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Which of the following is NOT a clinical presentation of acute gout?

1 - slow onset
2 - hot and red joint
3 - swollen joint
4 - pain/tender joint

A

1 - slow onset
- onset is abrupt

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Uric acid goes on to form monosodium urate and eventually forms monosodium urate crystals. In addition to building up in the joints, where else can this build up in the body?

1 - lungs
2 - heart
3 - liver
4 - kidney

A

4 - kidney
- filters uric acid, if this does not occur monosodium urate crystals can form in the kidneys causing kidney stones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

In an acute bout of gout, how long does it take for symptoms to peak?

1 - 4-6h
2 - 10-12h
3 - 16-20h
4 - 12-24h

A

4 - 12-24h
- uric acid levels are highest early in an acute flare up, before dropping off
- uric acid is not a great measure in an acute gout attack

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Measuring monosodium urate is the gold standard diagnosis for got. However, which of the following can also be useful when trying to diagnose a patient with gout?

1 - FBC to look for neutrophillia
2 - U&Es to look at renal function
3 - Liver function
4 - CRP as inflammation
5 - all of the above

A

5 - all of the above

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

There are some drugs that can reduce and some that increase the risk of gout. What 3 drugs/treatments can reduce the risk of gout?

1 - Losartan (BP), Fenofibrate (cholesterol) and vit C 500mg
2 - Losartan (BP), Aspirin and vit C 500mg
3 - Aspirin, Fenofibrate (cholesterol) and vit C 500mg
4 - Thiazide diuretics, Fenofibrate (cholesterol) and vit C 500mg

A

1 - Losartan (BP), Fenofibrate (cholesterol) and vit C 500mg
- low dose aspirin, diuretics, loop diuretics and thiazide diuretics ALL INCREASE risk of gout

22
Q

There are some drugs that can reduce and some that increase the risk of gout. What 2 drugs can increase the risk of gout?

1 - Losartan (BP) and Fenofibrate (cholesterol)
2 - Losartan (BP) and Aspirin
3 - Aspirin and Thiazide diuretics
4 - Thiazide diuretics, Fenofibrate (cholesterol)

A

3 - Aspirin and Thiazide diuretics

23
Q

A 65 y/o male patient presents with severe pain, 1st metatarsophalangeal (MTP) joint swelling, is otherwise well with apyrexial (without fever). What is the most likely diagnosis?

1 - RA
2 - gout
3 - osteoarthritis
4 - lupus

A

2 - gout
- key is podagra (pain and swelling in 1st MTP joint) as it occurs in 70% of patients with gout

24
Q

Gout can be treated effectively if identified and managed correctly. However, if not treated appropriately it can cause which of the following?

1 - tophi (monosodium urate) deposits in the joints
2 - polyarticular joint involvement
3 - long bouts of symptoms and chronic pain
4 - irreversible erosion of joint surfaces
5 - all of the above

A

5 - all of the above

25
Q

If a patient presents with an acute gout attack, what medication should be prescribed?

1 - Colchicine and NSAIDs
2 - Colchicine and aspirin
3 - thiazide diuretics and NSAIDS
4 - losartan and NSAIDs

A

1 - Colchicine and NSAIDs
- typically follows conservative management (rest, ice, elevation etc..)
- NSAIDs or COXIB 1st

  • Colchicine is a gout specific anti-inflammatory medication
  • NSAIDs reduce inflammation, which is common in gout
26
Q

NSAIDs or COXIB is typically the 1st line treatment for patients with an acute gout attack. Which patients should avoid this medication though?

1 - renal disease
2 - lung cancer
3 - previous stroke
4 - RA

A

1 - renal disease
- NSAIDs can induce further renal damage

27
Q

NSAIDs can be effective at reducing inflammation in acute gout attacks. How do NSAIDs help treat gout?

1 - increases uric acid secretion
2 - inhibits leukocyte migration to joints and phagocytes
3 -increases monosodium urate breakdown
4 - inhibits COX1- and 2

A

4 - inhibits COX1- and 2
- reduces prostaglandin production
- reduce general inflammation and are analgesic

28
Q

Colchicine is an anti-gout medication. What is the mechanism of action of this drug?

1 - increases uric acid secretion
2 - inhibits leukocyte migration to joints and phagocytes
3 -increases monosodium urate breakdown
4 - all of the above

A

2 - inhibits leukocyte migration to joints and phagocytes

  • phagocytes attempt to digest, engulf and remove crystals
  • instead phagocytes release H+ that can bind with urate anions forming unionised crystals
29
Q

Colchicine is an anti-gout medication. It works by inhibiting leukocyte and phagocyte migration to joints. Phagocytes attempt to digest, engulf and remove crystals, but instead phagocytes release H+ that can bind with urate anions forming unionised crystals and make the situation worse. What timeframe should Colchicine ideally be taken by a patient with an acute bout of gout?

1 - <24h
2 - <48h
3 - <72h
4 - anytime

A

2 - <48h

30
Q

If colchicine and NSAIDs are not effective or the patient cannot take them, what is an alternative medicine that can be used to treat an acute gout attack?

1 - allopurinol
2 - thiazide like diuretics
3 - steroids
4 - any of the above

A

3 - steroids
- can be oral or intra-articular
- if given intra-articular, may need to aspirate the joint first

31
Q

In gout the most common joint affected in 70% of patients is the metatarsophalangeal joint. Why is this joint so affected?

1 - contains more uric acid
2 - contains more prostaglandins
3 - hotter and better blood flow
4 - colder and poorer blood flow as in peripheries

A

4 - colder and poorer blood flow as in peripheries

  • solubility is lower at lower temperatures, so due to the cold the formation of crystals is more likely
32
Q

Uric acid is the key driver of gout. When is the best time to measure urate levels that may help identify those at risk of gout attacks?

1 - when they are well
2 - during acute gout attack
3 - following acute gout attack
4 - anytime

A

1 - when they are well
- if they have high uric acid levels this can be detected prior to a gout attack
- urate levels fall during acute gout attack

33
Q

Which of the following should be advised to patients regarding the long term conservative/non-pharmaceutical management of gout?

1 - weight loss
2 - dietary changes (lower alcohol, fats)
3 - exercise/PA
4 - address medicine that may increase uric acid (diuretics)
5 - all of the above

A

5 - all of the above

Medication switch example for hypertension could be:
- bendroflumethiazide = gout promoting
- losartan = non-gout promoting

34
Q

Although NSAIDs and Colchicine can be used to treat acute gout attacks. What is the 1st line core long term medication that we need to be aware of?

1 - low dose of aspirin
2 - vitamin C
3 - allopurinol
4 - chlorphenamine

A

3 - allopurinol
- remember purinol ending sounds like purines

  • 2nd line medication is febuxostat
35
Q

Allopurinol is the 1st line and febuxostat is the 2nd line core long term medication used to treat gout. What is the mechanism of action of both of these drugs?

1 - xanthine oxidase inhibitor
2increases uric acid secretion
3 - inhibits leukocyte migration to joints and phagocytes
4 -increases monosodium urate breakdown

A

1 - xanthine oxidase inhibitor

  • Hypoxanthine → xanthine → uric acid catalysed by xanthine oxidase
36
Q

What is the aim for maintaining uric acid levels below?

1 - <150 µmol/l
2 - <300 µmol/l
3 - <450 µmol/l
4 - <500 µmol/l

A

2 - <300 µmol/l
- keeping it below this will keep it way below the saturation level of 408 µmol/l

37
Q

A 65 year old male presents with on and off right knee swelling and severe pain. He is otherwise well with history of 1st metatarsophalangeal joint swelling, is apyrexial (no fever) and his eGFR is 55 (normal is >60). What investigation would we want to do 1st?

1 - X-ray
2 - full blood count
3 - blood tests for RA and ACPA
4 - knee aspiration

A

4 - knee aspiration

  • can see if crystals are present in the synovial fluid
  • tells us if the patient has gout and not osteoarthritis
38
Q

A 65 year old male presents with on and off right knee swelling and severe pain. He is otherwise well with history of 1st metatarsophalangeal joint swelling, is apyrexial (no fever) and his eGFR is 55 (normal is >60). The 1st investigation would be a knee aspiration to identify if crystals are present, which indicates gout. What treatment approach would we then use in this patient?

1 - rest
2 - NSAIDs
3 - allopurinol
4 - steroidal injection

A

4 - steroidal injection

39
Q

Which of the following is NOT a realistic differential for gout?

1 - septic arthritis
2 - RA
3 - Haemarthrosis – blood in joint (often post trauma and/or on anticoagulation)
4 - Pseudogout

A

2 - RA
- presents in a different clinical manner

40
Q

Pseudogout is a form of arthritis characterised by sudden, painful swelling in one or more of the joints, similar to gout. What is the cause of pseudogout?

1 - uric acid
2 - hyperalbuminaemia
3 - calcium pyrophosphate
4 - iron hydrophosphate

A

3 - calcium pyrophosphate

41
Q

Which of the following joints are NOT commonly affected by pseudogout?

1 - wrists
2 - spine
3 - knees
4 - ankles

A

2 - spine

Just like in gout the joint is hot and swollen joint

42
Q

What investigation would we want to do 1st in a patient with suspected pseudogout in an attempt to diagnose them?

1 - X-ray
2 - full blood count
3 - blood tests for RA and ACPA
4 - knee aspiration

A

4 - knee aspiration

This would show:

  • Positive birefringent rhomboid shaped calcium PyroPhosPhate crystal deposition (remember the Ps)
43
Q

Once we have aspirated a joint, we need to examine the fluid and look for the presence of crystals. There are 2 different types of crystals that we might see, positive and negative birefringent crystals. Match the positive and negative crystal appearance with their appearance under the microscope?

1 - Needle-shaped
2 - rhomboid shaped

A

1 - Needle-shaped = Negative shaped (both begin with N)

2 - rhomboid shaped = positive

44
Q

Once we have aspirated a joint, we need to examine the fluid and look for the presence of crystals. There are 2 different types of crystals that we might see, positive and negative birefringent crystals. Positive and negative crystals appear as rhomboids and needs under the microscope, respectively.

  • Positive birefringent crystals = Calcium pyrophosphate crystal deposition (CPPD)
  • Negative birefringent crystals = monosodium urate crystals

Which type of crystal is associated with gout and pseudogout?

A
  • gout = Negative birefringent Needle shaped crystals (remember the Ns)
    Negative + Needle begin with N
  • pseudogout = Positive birefringent rhomboid shaped calcium PyroPhosPhate crystal deposition (remember the Ps)
45
Q

Once we have aspirated a joint, we need to examine the fluid and look for the presence of crystals. There are 2 different types of crystals that we might see, positive and negative birefringent crystals. Positive and negative crystals appear as rhomboids and needs under the microscope, respectively.

  • Positive birefringent crystals = Calcium pyrophosphate crystal deposition (CPPD)
  • Negative birefringent crystals = monosodium urate crystals

A useful mnemonic to remember if the crystals are associated with gout or pseudogot is to remember the Ns and the Ps. What does the Ns and Ps relate to?

A
  • moNosodium urate crystals = Negative and Needle shaped = gout
  • Calcium PyroPhosPhate crystals = Positive charge = Pseudogout
46
Q

If a patients analysis of the fluid taken from the knee comes back with a report stating that there are positive birefringent crystals present, does the patient have gout or psuedogout?

A
  • pseduogout
  • P for Positive and Pseduogout
47
Q

A 55 year old male presents with sudden pain and swelling of the right knee. The crystals that have been found from the knee aspiration are positively birefringent. What is the diagnosis of the patient?

1 - pseudogout (calcium pyrophosphate disease)
2 - gout (calcium pyrophosphate disease)
3 - pseudogout (monosodium urate crystals)
4 - gout (monosodium urate crystals)

A

1 - pseudogout (calcium pyrophosphate disease)

48
Q

What does the term Chondrocalcinosis mean?

A
  • chondro = cartilage
  • calcinosis = calcified
  • the calcification of cartilage
49
Q

If we see an X-ray like below, we shouldn’t be able to see the cartilage in the joint space as it is translucent. However, in the image below we can see something in the joint space. What is this?

1 - ligaments
2 - calcified cartilage (chondrocalcinosis)
3 - torn cartilage
4 - bone

A

2 - calcified cartilage
- chondrocalcinosis due to excessive build up of calcium pyrophosphate present in pseudogout

50
Q

Calcium pyrophosphate dihydrate crystal deposition disease (CPPD), also called pseudogout is a form of arthritis that causes pain, stiffness, tenderness, redness, warmth and swelling (inflammation) in some joints. What is a conservative management approach?

1 - cold compression and immobilisation
2 - cold compression and steroids
3 - steroids and immobilisation
4 - steroids and NSAIDs

A

1 - cold compression and immobilisation

51
Q

Calcium pyrophosphate dihydrate crystal deposition disease (CPPD), also called pseudogout is a form of arthritis that causes pain, stiffness, tenderness, redness, warmth and swelling (inflammation) in some joints. What is the non-conservative treatment for an acute management approach?

1 - cold compression, immobilisation and NSAIDs
2 - cold compression, aspirin and steroids
3 - steroids, colchicine and immobilisation
4 - steroids, colchicine and NSAIDs

A

4 - steroids, colchicine and NSAIDs

52
Q

Although NSAIDs and Colchicine can be used to treat acute gout attacks. Long term medication includes Allopurinol. What is the mechanisms of action of Allopurinol?

A
  • hypoxanthine is a naturally occurring purine
  • hypoxanthine is converted into xanthine by xanthine oxidase
  • xanthine is a purine that is converted into uric acid by xanthine oxidase
  • ALLOPURINOL INHIBITS xanthine oxidase and reduces uric acid formation
    patient should not get gout when on ALLOPURINOL

A. MLA Map General Practice and Primary Healthcare (28 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions