Brainscape's Knowledge GenomeTM

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


See full index

ICM Exam 2: Infectious Disease (& CIA) > Crystal induced arthropathies > Flashcards

Crystal induced arthropathies Flashcards

1
Q

Uric acid solubility limit

A

6.8 mg/dL

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

Medication that predisposes to gout

A

Thiazides

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

Congenital syndrome that predisposes to gout

A

Lesch Nyhan (HGPRT deficiency)

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

Uric acid excretion

A

80% renal

20% GI

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

Key player in acute gout flare

A

IL1

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

Causes of Hyperuricemia (seondary to…)

A

10% secondary to overproduction

90% to underexcretion

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

Rreactions using HGPRT

A

Guanine to Guanylic acid

HX to Inosinic acid

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

Uric Acid Secondary overproduction

(excluding alcohol and purine foods)

A
  • Myelo/Lympho proliferative
  • Malignancy
  • Hemolytic diseases
  • Psoriasis
  • Obesity
  • Chemo
  • Down Syndrome
  • Glycogen storage disease
  • Pancreatic extract, Nicotinic acid
  • B12 deficiency
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Why does alcohol increase risk for hyperuricemia

A

needs ATP = higher puine turnover

Lactate elevation and decreased renal excretion via URAT-1

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

Majority of renal excretion uses..

A

complex series of transport proteins

URAT

OAT

NPT

ABCG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Kidney excretes of about ___% of filtered urate load

A

10%

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

__% of urate is re-secreted

A

50%

80% of the resulting load is reabsorbed in the ascending limb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Primary causes of underexcretion

A

Deficiency of Urate transporter (exporter)

Medulary cystic kidney disease (kids)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Secondary renal underexcretion causes

A
  • Kidney disease
  • Lactic acidosis/ DKA
  • Dehydration
  • HypoPTH and Hypothyroidism
  • Sarcoid
  • Preeclampsia
  • SODIUM WASTING or VOLUME DEPLETION
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Drugs that promote hyperuricemia

A
  1. Thiazides, loop diuretics
  2. Orgaic acids (salicyclate, NA, Pyrizinamide)
  3. Cylcosporine
  4. ethambutol
  5. levadopa
  6. CSF
  7. Lead Tox.
  8. Laxative abuse
  9. Severe salt restriction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What hppens when gout spreads beyond joint

A

Tenosynovitis mimicking cellulitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Diagnosis of gout involves

A

Joint aspiration!

HU + joint effusion NOT enough for definitive

Can mimic septic arthritis

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

____ are good at finding gouty erosions

A

MRI/CT

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

Sign for gout in ultrasound

A

Double contour sign (urate icing) = irregular band on surface of articular cartilage

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

Most important indication for arthrocentesis

A

check for septic arthritis

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

WBC above ____ assume septic and give AB

A

50k

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

difference between blood from traumatic aspiration and hemarthrosis?

A

Red streaks in otherwise yellow fluid = TA

Homogenously bloody and NO clot = HA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Specificity for MSU visualization on polarized light

A

Near 100%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Three stages of gout

A

Acute

Intercritical

Chronic Tophaceous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Other complications for gout

A

Bursitis

Tenosynovitis

Tendinitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Most untreated gout patient will have…

A

recurrence within 2 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Bony erosions and deformaties occur during

A

Chronic recurrent gout

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Defining characteristic of tophaceous gout

A

Solid urate deposits in tissues

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Tx goal to prevent disease progression

A

Lower urate to less than 6mg/dL = deplete urate from serum

(also to correct the underlying cause)

30
Q

Tx combo for acute gout

A

NSAID + Colchicine + GC’s + IL-1b antagonist

31
Q

What dont you do during a flare?

A

Dont try to lower urate levels!

You’ll make the attack worse because crystals will get mobilized.

32
Q

Medication to increase excretion

A

Probenecid

33
Q

What to do after first attack?

A

Avoid dehydration

Modify meds (losartan)

Reduce alcohol intake

Lose weight

34
Q

Medications to reduce production

A

allopurinol

febuxostat

PEG-uricase

35
Q

Prophylaxis against attacks with…

A

Colchicine and NSAIDs

36
Q

Uricosuric agents:

Function

Examples

A

increases secretion into urine

Probenecid - Potent, limited use in CKD and nephrolithiasis

Benzbromarone = less potent but can be used in renal disease

Losartan or Fenofibrate = for mild disease with HTN or hyperlipidemia

37
Q

Allopurinol MOA

May be effective in ______

Sides?

A

XO inhibitor

underexcretors

Toxic epidermal necrolysis, vasculitis, BM supression

38
Q

Interaction with allopurinol

A

thiazide use or allergy to Pen

39
Q

Febuxostat MOA

A

blocks XO

no dose adjustment for renal patients

40
Q

Uricase enzymes function

A

Catalyzes the oxidation of uric acid o 5OH isourate

–> converted to allantoin (excreted)

*humans have a NONFUNTIONAL gene for uricase (because uric acid is a powerful antioxidant)

41
Q

Uricase enzymes examples:

A

Pegloticase = recombinant porcine uricase, modified by covalent linkage to PEG

**reserved for refractory tophaceous gout

**prophylaxis with colchicine NSAIDs or CS for first 6 months

Rasburicase = nonPegylated recombinant uricase = for BRIEF cuorses and prevention of neuropathy

42
Q

CPPD etiology

A

Excessive cartilage pyrophosphate production leads to CPPD crystals deposit in

  • Joint hylaine cartilage
  • fibrocartilage
  • ligaments
43
Q

Acute release of CPPD crystals into joint space causes _______________ >> _____________

A

phagocytosis by MQ

Release of chemotactic substances and activation of inflammasome

44
Q

CPPD can cause _____

A

chondrocalcinosis

45
Q

CPPD doesnt always have radiographic evidence, so ___ is helpful

A

US

46
Q

Extracellular …….. yields PP

A

EC ATP scavenging by nucleoside triphosphate pyrophosphate hydrolase yields PP

47
Q

CPPD prevalenece

A

equal in gender, increases with age

48
Q

CPPD a complication of ____

A

primary OA

49
Q

Other diseases that predispose to CPPD

A

Familial chondrocalcinosis

Gitelman syndrome

50
Q

Explain Gitelman

A

Mimics thiazide

presents with Hypokalemia, Met. Acidosis, hypoMagnesemia, Hypocalciuria, and normal BP

51
Q

What systemic metabolic disease associates with CPPD

A

Primary Hyperparathyroidism

52
Q

pseudogout typically affects

A

larger joints (knee)

53
Q

pseudogout flares following…

A

parathyroidectomy

(low calcium = partial dissolution of crystals = release into joint fluid)

54
Q

Pseudogout aka

A

acute CPP crystal arthritis

55
Q

Chronic CPP inflammatory arthritis aka

A

pseudo-RA

56
Q

In pseudo-RA, Radiographic changes are…

A

more typical of OA than RA

57
Q

CPPD crystals are ___ refringent and ____ whe parallel to the light

A

Positive

Blue

58
Q

CPPD aspirate tends to be

A

inflammatory

(90% PMN with 15-30k cells)

59
Q

X ray findings of CPPD

A
  • Beak like projections at 2nd/3rd Metacarpal heads
  • Subchondral cysts
  • chondrocalcinosis
60
Q
A
61
Q

CPPD deposits present with…

A
  • Hyperechoic bands parallel to cartilage surface of knee
  • Punctate pattern with hyperechoic spots
  • Homogenous hyperechoic nodular or oval deposits in bursae
62
Q

Treatment of pseudogout involving more than one joint

A

intraarticular glucocorticoids

63
Q

Indications for pseudogout prophylaxis

A

if more than 3 per year = low dose colchicine

Refractory or chronic = MTX or hydroxychloroquine

Reurrent acute or severe = IL-1b inhibitor

64
Q

Other deposition closely tied to OA

A

Hydroxyaapatite (Basic Ca Phosphate) crystals

65
Q

Elderly women get this with Hydroxyapatite deposition disease

A

Milwaukee shoulder

extremely destructive, hemorrhagic ffusions, synovial fluid has BCP crystals

66
Q

BCP Tx

A
  • NSAID or COX2 inhibitors
  • Intra-articular injections
  • Local irrigation
  • ULTRASOUND to degrade crystals

*Agents to lower phosphate levels = resorption of deposits in RF patients

67
Q

Calcium Oxalate Deposition Disease:

Primary and secondary disease =

Ascorbate metabolism and clearance =

A

Primary = enyme defect, overproduction of oxalic acid = nephrocalcinosis

Secondary = MORE COMMON, metabolic abnormality complicating end-stage renal disease

*Ascorbate is metabolozed to oxalate… inadequately cleared in uremia and by dialysis patients

68
Q

CaOx induced synovial effusions are usually ____

A

Noninflammatory

69
Q

Shape of CaOx

A

Bipyramidal

Stain with ALIZARIN RED

70
Q

CaOx therapy

A

NSAIDs

Colchicine

IA GC’s

LIVER TRANSPLANT in primary oxalosis

ICM Exam 2: Infectious Disease (& CIA) (10 decks)

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