Gout and Other Crystal-Associated Arthropathies

Question 0

Most common early clinical manifestation of gout

Answer 0

Acute arthritis

Question 1

Polarized microscopy alone can identify most typical crystals except this one

Answer 1

Apatite

Question 2

Most commonly involved joint in gout

Answer 2

1st MTP

Question 3

Characteristic of monosodium urate crystals on polarized microscopy

Answer 3

Brightly birefringent with negative elongation; needle-shaped

Question 4

Arthrocentesis of these joints is a useful technique to establish the diagnosis of gout between attacks because MSU crystals can be demonstrated even when they are not acutely involved with gout

Answer 4

1st MTP and knees

Question 5

Reason why serum uric acid may be normal or low at the time of an acute attack of gout

Answer 5

Inflammatory cytokines can be uricosuric

Question 6

Excretion of this amount of uric acid per 24 h on a regular diet suggests that causes of overproduction of purine should be considered

Answer 6

> 800 mg in 24 h

Question 7

Mainstay of treatment during an acute gouty attack

Answer 7

Anti-inflammatory drugs (NSAIDs or glucocorticoids)

Question 8

Best drug to lower serum urate in overproducers, urate stone formers, and patients with renal disease

Answer 8

Allopurinol

Question 9

Uricosuric drug that is more effective than probenecid in patients with renal failure

Answer 9

Benzbromarone

Question 10

Toxicity of allopurinol has been recognized increasingly in patients who use this diuretic

Answer 10

Thiazide

Question 11

Toxicity of allopurinol has been recognized increasingly in patients who are allergic to these antibiotics

Answer 11

Penicillin and ampicillin

Question 12

Most serious side effects of allopurinol

Answer 12

TEN, systemic vasculitis, bone marrow suppression, granulomatous hepatitis, renal failure

Question 13

A specific xanthine oxidase inhibitor that does not require dose adjustment in mild to moderate renal disease

Answer 13

Febuxostat

Question 14

Duration of colchicine prophylaxis in patients given hypouricemic therapy

Answer 14

Until patient is normouricemic and without gouty attacks for 6 months or as long as tophi are present

Question 15

A new urate-lowering biologic agent that can be effective in patients allergic to or failing xanthine oxidase inhibitors

Answer 15

Pegloticase

Question 16

Mutations in this gene can increase elaboration and extracellular transport of pyrophosphate, leading to CPPD arthropathy

Answer 16

ANKH gene

Question 17

Most frequently affected joint in CPPD arthropathy

Answer 17

Knee

Question 18

Findings of punctate and/or linear radiodense deposits in fibrocartilaginous joint menisci or articular hyaline cartilage; seen in CPPD arthropathy

Answer 18

Chondrocalcinosis

Question 19

Polarized light microscopy findings in pseudogout (CPPD arthropathy)

Answer 19

Rhomboid, square, or rodlike crystals with weak positive birefringence

Question 20

Chondrocalcinosis not due to CPPD deposition in patients with chronic renal failure is due to accumulation of this crystal

Answer 20

Calcium oxalate

Question 21

Prophylactic treatment for frequent recurrent attacks of pseudogout

Answer 21

Colchicine

Question 22

Primary mineral of normal bone and teeth

Answer 22

Apatite

Question 23

Destructive chronic arthropathy of the shoulder in the elderly, associated with apatite deposition disease

Answer 23

Milwaukee shoulder

Question 24

Most common sites of apatite deposition are the bursae and tendons in and around these joints

Answer 24

Knees, shoulders, hips, and fingers

Question 25

Usual synovial fluid leukocyte count in calcium apatite deposition disease

Answer 25

<2000/uL

Question 26

Type of microscopy used in the definitive diagnosis of apatite arthropathy

Answer 26

Electron microscopy

Question 27

Color of apatite aggregates with Wright’s stain

Answer 27

Purple

Question 28

Color of apatite aggregates with alizarin red S stain

Answer 28

Bright red

Question 29

Vitamin that should be avoided in renal failure patients because it is metabolized to oxalate and is inadequately cleared in uremia and by dialysis

Answer 29

Ascorbic acid