Brainscape's Knowledge GenomeTM

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


See full index

Rheumatology > Crystal Disease > Flashcards

Crystal Disease Flashcards

1
Q

What is gout and what crystal type is involved?

A

Gout is an inflammatory arthritis associated with hyperuricaemia and intra-articular monosodium urate crystals

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

What is normal purine metabolism?

A
  • Half of uric acid pool derived from endogenously synthesized purine nucleotides; rest from ingested dietary purines.
  • 60% of pool is replenished daily by catabolism of purine nucleotides and bases.
  • Uric acid is the end product of purine metabolism
  • Two-thirds of uric acid formed each day is excreted by the kidney and one-third is eliminated via the gastrointestinal tract
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the features of gout?

A
  • Acute monarthropathy - sudden onset, severe pain - especially on movement
  • Tophi (in very high urate levels)- Urate deposits over extensor surface, especially elbows, knees and achilles tendon
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the risk factors associated with gout?

A
  • Male
  • Menopause
  • Increased age
  • Heredity
  • Alcohol Excess
  • Diuretics
  • Increased dietary purines
  • Leukaemia
  • Renal disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What would be the differential diagnosis for someone presenting with features of gout?

A
  • Septic arthritis
  • Haemarthritis
  • CPPD
  • Palindromic RA
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What investigations would you do for suspected gout?

A

Clinical Diagnosis

Bloods

  • Serum Urate - usually raised, can be normal

Imaging

  • X-Ray - soft tissue swelling, punched out lesions

Other

  • Polarised microscopy of aspirate - Negatively bifringent urate crystals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How would you treat someone with gout?

A

Acute Gout

  • NSAIDs
  • Colchicine
  • Steroids

Chronic Gout

  • Treat hyperuricaemia if symptomatic
  • Prevention measures
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What prophylaxic medications would you use for someone with gout?

A

Medications - >1 attack in 12 months

  • Allopurinol
  • Febuxostat
  • Uricosuric drugs - increase excretion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is pseudogout?

A
  • Acute monoarthropathy of larger joints in elderly patients
  • Spontaneous and self limiting
  • Crystal involved is calcium pyrophosphate dihydrate (CPPD) - shed from cartilage into articular space, which leads to an inflammatory response
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the risk factors for pseudogout?

A
  • Old age
  • Hyperparathyroidism
  • Haemochromatosis
  • Hypophosphataemia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What can trigger pseudogout?

A
  • Trauma
  • Intercurrent illness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the clinical features of pseudogout?

A
  • Inflammatory arthritis - knee pain classical presentation
  • Risk Factors - metabolic conditions, surgery, kidney stones, DM, liver disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How would you investigate suspected pseudogout?

A

Clinical Diagnosis

Imaging

  • X-ray - Soft tissue calcium deposition

Other

  • Polarised light microscopy - Weakly positive birefringent crystals
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the treatment for pseudogout?

A
  • NSAIDs
  • I/A Steroids
  • No prophylactic therapies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What are the causes of Hyperuricaemia?

A
  • Overproduction - Malignancy, Drugs, HGPRT deficiency, severe psoriasis
  • Under excretion - Renal impairment, HTN, hypothyroid, drugs, alcohol, lead posoning, exercise, starvation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How would you manage someone with Hyperuricaemia?

A

1st Attack

  • No treatment, unless - single attack polyarticular gout, tophaceous gout, urate calculi, renal insufficiency

2nd Attack - within a year

  • Treat

Prophylaxis

  • Prior to treating malignancies

Do not treat asymptomatic hyperuricaemia

19
Q

What medications could you use in to treat hyperuricaemia?

A

Wait for attack to subside before treating - use NSAIDs and low dose colchicine until urate levels are normal

  • Allopurinol - xanthine oxidase inhibitors
  • Febuxostat
  • Uricosuric drugs
  • Canakinumab

Adjust dose according to renal function

20
Q

Why does the menopause increase a womens risk of developing gout?

A

Oestrogen has uricosuric effect → Urate levels rise after menopause

21
Q

What lifestyle factors need to be addressed in someone with gout?

A
  • Weight loss
  • Avoid prololnged fasts
  • Avoid alcohol excess
  • Avoid purine rich meals
22
Q

Which joints are most commonly affected in gout?

A
  • MTPJ - most common
  • Small joints of the hand
  • Wrist
  • Elbow
  • Knee
23
Q

Which joint does pseudogout classically affect?

A

The knee

24
Q

What is podagra?

A

Gout of the foot, especially the big toe.

25
Q

What is the average time span of an acute episode of gout?

A

3-7 days

26
Q

What type of crystals are implicated in gout?

A

Monosodium urate crystals

27
Q

What type of crystals are implicated in pseudogout?

A

Calcium pyrophosphate dihydrate

28
Q

Are pseudogout crystals positively or negatively bifringent?

A

Positively bifringent

Psuedogout is Positive

29
Q

Are gout crystals positively of negatively bifringent crystals?

A

Negative

Rheumatology (20 decks)

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