Exam 3 Gout, Pseudogout, Lupus Flashcards
uric acid is a product of?
purine metabolism
Dx and key Sx of excess uric acid
gout.
overproduction of uric acid caused by?
malignancy, enzyme defects
classic age for gout M and F?
men over 30, women postmenopausal
common comorbidity of gout?
renal stones, by a factor of 1000
dietary causes of gout?
alcohol, high purine foods like organ meats, spinach, asparagus, beans etc
stage 1 of gout and how to diagnose?
asymptomatic hyperuricemia, diagnose with uric acid levels. rarely diagnosed at this stage
stage2 of gout and how to diagnose?
acute gouty arthritis, pain. usually post alcohol, uric rich food binge.
stage 3 of gout and how to diagnose?
intercritical gout, intermittent attacks, normal triggers.
stage 4 of gout and how to diagnose?
chronic tophaceous gout. presence of tophi
gold standard gout Dx test?
arthrocentisis with culture and gram stain, look for urate crystals NEGATIVELY BIREFRIGENT
the less optimal test for gout Dx?
serum uric acid. elvated does not always predict gout.
complications of gout seen on Xray?
joint erosion, “rat bite” appearance
which joint does gout prefer?
usually first joint, usually big toe.
how many stages of gout Tx and what are they?
3 stages. acute, prophylaxis, lower uric acid stores
first line Tx for acute attack of gout?
NSAIDS. indomethacin (often appears on board)
contraindications of indomethacin?
gi bleed, renal impairment, PUD
what must be ruled out before steroid Tx of gout?
bacterial infection. steroids will exacerbate.
2nd line Tx of acute gout?
Colchicine, rarely used. lots of side effects
best drug for gout prevention?
Colchicine, same as the drug rarely used 2nd line for acute Tx
best drug for long term management of gout overproducers?
allopurinol, prevention only.
best drug for long term management of gout underproducers?
probenecid
patients of great concern when treating gout?
those with renal issues
pseudogout causative agent?
CPPD calcium crystals
most common age group pseudogout?
elderly
joints affected by psuedogout?
50% in knees, then anywhere else including larger joints
DDx of pseudogout and osteoarthritis and RA?
pseudogout has redness in addition to pain. OA only pain no redness. RA order rheumatoid factor test
finding of pseudogout fluid aspiration?
positively birefringent. true gout is negative birefrigent.
Tx for pseudogout?
aspiration, NSAIDs
prophylaxis for pseudogout?
colchicine. use caution. many side effects
cause of SLE?
autoimmune. research ongoing
demographic of SLE?
females 7 times more likely, black women 4 times more
etiology of SLE?
antigen/antibody complexes deposited in tissue
key Sx of SLE?
MALAR butterfly rash (only systemic, not discoid), photosensitivity, sometimes alopecia
board test concern for SLE?
raynaud’s phenomenon often described on boards along with malar rash
initial lab tests for SLE?
antinuclear antibody and erythrocyte sedimentation rate
SLE Tx?
NSAIDs first line. depends on severity of illness
possible complications of SLE?
lupus nephritis, CNS involvement, thrombocytopenia, antiphospholipid antibodies
how to Dx drug induced SLE?
anti-hitone antibody test if pt. taking a drug for more than a month presenting with SLE Sxs
major drug associated with drug induced SLE?
procainamide
course of SLE?
chronic, relapsing and remitting.
sjorgen syndrome associations?
SLE, RA
presentation of SS?
chronic lacrimal and salivary gland dysfxn. dry eye, dry mouth. low production of tears and saliva (sicca Sx)
Tx of SS?
saliva replacement, artificial tears, NSAIDs
mechanism of scleroderma/systemic sclerosis?
tighten and thicken tissues. narrowing small vasculature. scleroderma on the skin. systemic sclerosis, organs/connective tissue etc.
board concern for scleroderma/systemic sclerosis?
CREST syndrome, limited classification
lab tests for scleroderma/systemic sclerosis?
ANA positive, anti centromere antibodies (ACA)
Tx for scleroderma/systemic sclerosis?
Sx and supportive. Tx Raynaud’s with calcium channel blockers
