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Musculoskeletal system > Gout and pseudogout > Flashcards

Gout and pseudogout Flashcards

1
Q

Gout: what is it?

A

acute inflammatory monoarthritis caused by precipitation of monosodium urate crystals

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2
Q

Does gout cause mono- or multi-arthritis?

A

mono

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3
Q

what causes gout?

A

monosodium urate crystals

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4
Q

acute inflammatory monoarthritis caused by precipitation of monosodium urate crystals. what is this?

A

gout

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5
Q

what are risk factors for gout?

A

hyperuricemia (strongest)

male
hypertension
obesity
diabetes
dyslipidemia
alcohol use

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6
Q

hyperuricemia is a risk factor for what?

A

gout

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7
Q

what can cause hyperuricemia?

A
  • underexcretion (90% of patients): idiopathic
    (sometimes potentiated by renal failure)

overproduction (10% of patients)

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8
Q

what can exarcerbate underexcretion of uric acid?

A

alcohol and medications such as diuretics

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9
Q

what conditions can cause overproduction of uric acids?

A

Lesch-Nyhan syndrome (genetic kidney failure disorder)
PRPP excess
increased cell turnover (tumor lysis syndrome)
van Gierke disease (can’t break down glycogen)

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10
Q

hyperuricemia
male
hypertension
obesity
diabetes
dyslipidemia
alcohol use

risk factors for what?

A

gout

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11
Q

what do gout crystals look like under microscope?

A

needle shaped and +birefringent (yellow on parallel light, blue under perpendicular light)

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12
Q

what is the shape of gout crystals?

A

needle

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13
Q

what is +birefringent?

A

yellow under parallel light
blue under perpendicular light

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14
Q

needle shaped +birefringent crystals under microscope. what is it?

A

gout crystals (uric acid)

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15
Q

can serum uric acid levels during gout attack be normal?

A

yes

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16
Q

are serum uric acid levels during gout attack always elevated?

A

no

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17
Q

Gout: symptoms?

A

joint swollen, red, painful (asymmetric). classically of big toe

tophus formation on ears, elbow, achilles tendon

after certain events (meals, alcohol, surgery, trauma, diuresis, dehydration)

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18
Q

after which events does a gout attack usually occur?

A

after big meal rich in purines (red meat, seafood)
alcohol consumption
trauma
surgery
dehydration
diuresis

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19
Q

which foods are rich in purines?

A

red meat, seafood

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20
Q

what is the classic manifestion of gout?

A

red, painful, swollen MTP joint of big toe (podagra)

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21
Q

what is podagra?

A

red, painful, swollen MTP joint of big toe

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22
Q

where is the MTP joint?

A

foot

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23
Q

where is the MCP joint?

24
Q

another name for red, swollen, painful MTP joint of big toe?

25
Q

where do gout tophi usually occer?

A

ear, olecranon (elbow) and achilles heel

26
Q

red, painful, swollen MTP joint of big toe. suggestive of?

27
Q

why can alcohol (beer more than spirits) consumption trigger gout?

A

metabolitis compete for the same excretion sites in kidney as uric acid

uric acid therefore builds op in blood

28
Q

gout: treatment?

A

colchicine
NSAIDs
glucocorticosteroids

29
Q

what does colchicine do?

A

inhibits innate immune system. stops inflammatory reaction

gout treatment

30
Q

what is the preventive treatment of gout?

A

allopurinol
(inhibits enzyme that produces uric acid)

febuxostat

31
Q

what does allopurinol do?

A

inhibits enzyme that produces uric acid

32
Q

what is another name for pseudogout?

A

calcium pyrophosphate deposition disease

33
Q

what is another name for calcium pyrophosphate deposition disease?

A

pseudogout

34
Q

what happens in pseudogout?

A

deposition of calcium pyrophosphate crystals in the joint spaces

35
Q

what happens in pseudogout calcium pyrophosphate deposition disease?

A

deposition of calcium pyrophosphate crystals in the joint spacesw

36
Q

what is the old name for calcium pyrophosphate deposition disease?

A

pseudogout

37
Q

calcium pyrophosphate deposition disease: how old are the patients, which sex M/F?

A

> 50 y/o
both sexes affected affected equally

38
Q

calcium pyrophosphate deposition disease: most common cause is idiopathic?

39
Q

calcium pyrophosphate deposition disease: what is it associated with?

A

hemochromatosis
hyperparathyriodism
joitn trauma

40
Q

hemochromatosis
hyperparathyriodism
joint trauma

associated with what?

A

calcium pyrophosphate deposition disease

41
Q

deposition of calcium pyrophosphate crystals in the joint spaces

what is this?

A

calcium pyrophosphate deposition disease or pseudogout

42
Q

calcium pyrophosphate deposition disease: acute symptoms?

A

pain and swelling with acute inflammation of joint

most commonly knee

43
Q

what is the most commonly affected joint in calcium pyrophosphate deposition disease?

44
Q

calcium pyrophosphate deposition disease: chronic symptoms?

A

degeneration of joint

45
Q

how do you call chronic pseudogout?

A

pseudo-osteoarthritis

46
Q

what is pseudo-osteoarthritis?

A

chronic pseudogout (calcium pyrophosphate depostion disease)
which causes degeneration of joint

47
Q

calcium pyrophosphate deposition disease: x-ray finding?

A

chondrocalcinosis (calcium in cartilage within joint space)

48
Q

chondrocalcinosis in joint on x-ray. suggestive of what?

A

calcium pyrophosphate deposition disease

49
Q

calcium pyrophosphate deposition disease: what do crystals under microscope look like?

A

rhomboid (ruit)
weakly +birefringent (blue when parallel to light)

50
Q

Crystals under microscope:
rhomboid (ruit)
weakly +birefringent (blue when parallel to light)

which disease?

A

calcium pyrophosphate deposition disease

51
Q

Acute treatment calcium pyrophosphat deposition disease?

A

colchicine
NSAIDs
glucocorticosteroids

(same as gout)

52
Q

what is weakly +birefringent?

A

blue when under parallel light

(pseudogout)

53
Q

what is prophylaxis for calcium pyrophosphate deposition disease?

A

colchicine

54
Q

what are the ‘blue P’s’ of calcium pyrophosphate deposition disease?

A

blue Parallel (weakly +birefringent)
Positive birefringent
calcium Pyrophosphate
Pseudogout

Musculoskeletal system (17 decks)

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