Gout

Question 1

Scientific name of gout

Answer 1

Mono sodium urate crystal deposition disease

Question 2

What is gout and the cardinal feature

Answer 2

Inflammatory arthritis

Hyperuricemia

Question 3

Uric acid is the breakdown product fo what

Answer 3

Purines

Question 4

What serum uric acid level is hyperuricemia

Answer 4

Exceeding 6.8 mg/dL

Question 5

Presentation of acute gout flare

Answer 5

*monoarticular 80-90%
Can be poly articular 15%

1st MTP joint “podagra” most common

Others: ankle, heel, knee, wrist, fingers, elbow

*often recurrent

Self limiting about 2 weeks

Question 6

Meds for acute gout flares

Answer 6

*thiazide or loop diuretics
Low dose aspirin 
Niacin
Cyclosporine A
*urate-lowering medications

Question 7

Acute flare history and physical exam

Answer 7

Rapid onset *night
*severe pain
Pain peaks within 8-12 hours
Redness warmth swelling
Fever chills malaise

Mono or poly articular
Signs of inflammation
*may resemble cellulitis
Decreased ROM

Question 8

Radiography of gout

Answer 8

Early: soft tissue swelling
Established disease: bony erosions “punched out” with sclerotic margin, overhanging edges “rat bite erosions”
MRI
Ct
Ultras
Dual energy ct DECT to identify urate deposits and tophi

Question 9

Diagnostic gout

Answer 9

• arthrocentesis/synovial fluid analysis. *definitive
• examination for crystals (polarized light microscopy)

-polarized light microscopy
*monosodium urate crystals
Needle shaped
Negatively birefringement

Serum uric acid can be normal during acute flare so *not best test