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Clin Med > Exam 3 Gout, Pseudogout, Lupus > Flashcards

Exam 3 Gout, Pseudogout, Lupus Flashcards

1
Q

uric acid is a product of?

A

purine metabolism

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2
Q

Dx and key Sx of excess uric acid

A

gout.

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3
Q

overproduction of uric acid caused by?

A

malignancy, enzyme defects

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4
Q

classic age for gout M and F?

A

men over 30, women postmenopausal

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5
Q

common comorbidity of gout?

A

renal stones, by a factor of 1000

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6
Q

dietary causes of gout?

A

alcohol, high purine foods like organ meats, spinach, asparagus, beans etc

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7
Q

stage 1 of gout and how to diagnose?

A

asymptomatic hyperuricemia, diagnose with uric acid levels. rarely diagnosed at this stage

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8
Q

stage2 of gout and how to diagnose?

A

acute gouty arthritis, pain. usually post alcohol, uric rich food binge.

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9
Q

stage 3 of gout and how to diagnose?

A

intercritical gout, intermittent attacks, normal triggers.

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10
Q

stage 4 of gout and how to diagnose?

A

chronic tophaceous gout. presence of tophi

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11
Q

gold standard gout Dx test?

A

arthrocentisis with culture and gram stain, look for urate crystals NEGATIVELY BIREFRIGENT

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12
Q

the less optimal test for gout Dx?

A

serum uric acid. elvated does not always predict gout.

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13
Q

complications of gout seen on Xray?

A

joint erosion, “rat bite” appearance

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14
Q

which joint does gout prefer?

A

usually first joint, usually big toe.

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15
Q

how many stages of gout Tx and what are they?

A

3 stages. acute, prophylaxis, lower uric acid stores

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16
Q

first line Tx for acute attack of gout?

A

NSAIDS. indomethacin (often appears on board)

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17
Q

contraindications of indomethacin?

A

gi bleed, renal impairment, PUD

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18
Q

what must be ruled out before steroid Tx of gout?

A

bacterial infection. steroids will exacerbate.

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19
Q

2nd line Tx of acute gout?

A

Colchicine, rarely used. lots of side effects

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20
Q

best drug for gout prevention?

A

Colchicine, same as the drug rarely used 2nd line for acute Tx

21
Q

best drug for long term management of gout overproducers?

A

allopurinol, prevention only.

22
Q

best drug for long term management of gout underproducers?

A

probenecid

23
Q

patients of great concern when treating gout?

A

those with renal issues

24
Q

pseudogout causative agent?

A

CPPD calcium crystals

25
Q

most common age group pseudogout?

A

elderly

26
Q

joints affected by psuedogout?

A

50% in knees, then anywhere else including larger joints

27
Q

DDx of pseudogout and osteoarthritis and RA?

A

pseudogout has redness in addition to pain. OA only pain no redness. RA order rheumatoid factor test

28
Q

finding of pseudogout fluid aspiration?

A

positively birefringent. true gout is negative birefrigent.

29
Q

Tx for pseudogout?

A

aspiration, NSAIDs

30
Q

prophylaxis for pseudogout?

A

colchicine. use caution. many side effects

31
Q

cause of SLE?

A

autoimmune. research ongoing

32
Q

demographic of SLE?

A

females 7 times more likely, black women 4 times more

33
Q

etiology of SLE?

A

antigen/antibody complexes deposited in tissue

34
Q

key Sx of SLE?

A

MALAR butterfly rash (only systemic, not discoid), photosensitivity, sometimes alopecia

35
Q

board test concern for SLE?

A

raynaud’s phenomenon often described on boards along with malar rash

36
Q

initial lab tests for SLE?

A

antinuclear antibody and erythrocyte sedimentation rate

37
Q

SLE Tx?

A

NSAIDs first line. depends on severity of illness

38
Q

possible complications of SLE?

A

lupus nephritis, CNS involvement, thrombocytopenia, antiphospholipid antibodies

39
Q

how to Dx drug induced SLE?

A

anti-hitone antibody test if pt. taking a drug for more than a month presenting with SLE Sxs

40
Q

major drug associated with drug induced SLE?

A

procainamide

41
Q

course of SLE?

A

chronic, relapsing and remitting.

42
Q

sjorgen syndrome associations?

A

SLE, RA

43
Q

presentation of SS?

A

chronic lacrimal and salivary gland dysfxn. dry eye, dry mouth. low production of tears and saliva (sicca Sx)

44
Q

Tx of SS?

A

saliva replacement, artificial tears, NSAIDs

45
Q

mechanism of scleroderma/systemic sclerosis?

A

tighten and thicken tissues. narrowing small vasculature. scleroderma on the skin. systemic sclerosis, organs/connective tissue etc.

46
Q

board concern for scleroderma/systemic sclerosis?

A

CREST syndrome, limited classification

47
Q

lab tests for scleroderma/systemic sclerosis?

A

ANA positive, anti centromere antibodies (ACA)

48
Q

Tx for scleroderma/systemic sclerosis?

A

Sx and supportive. Tx Raynaud’s with calcium channel blockers

Clin Med (15 decks)

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