Gout - Ix + Mx

Question 1

Investigation;

Bloods: ???, ??? & serum ? ?.
o ? does not confirm gout, and a ? uric acid level
during an ? attack does not exclude gout, as levels ? as part of the ? ? reaction

Answer 1

fbc
u+e
uric acid
hyperuricaemia
normal
acute
fall
acute phase

Question 2

Ix
? of the joint effusions;

o For ??? and ? light microscopy.
o In acute gout, ? fluid shows increased ? due to the elevated cell count.
o Urate crystals will be ? ? and ? shaped in
polarised light microscopy.

Answer 2

aspiration
mcs
polaraized
synovial
turbidity
negatively biorefringent
needle

Question 3

Ix
XR can assess the ? of joint damage; usually ? in early disease, but with long-standing disease the changes of ?? may develop

Gouty ‘erosions’ (? ?) are a less common but more specific feature,
appearing as periarticular ‘? ?’ defects.

In the longer-term, it may be prudent to search for an underlying cause, with
blood ?, urine ?, blood ?/?, and FBC/???
(? conditions) performed during remission.

Answer 3

degree
minimal
oa
bony tophi
punched out
pressure
dip
glucose/lipids
ESR
myeloproliferative

Question 4

Management
The Acute Episode of Gout;

?-acting oral NSAID (e.g. ?/?).
o Oral ? is used instead of NSAIDs in ? patients, patients
with ??? or if on ?.

Early ? of the joint combined with ? injection can
effectively abort the acute attack.
0 Only really in ? care with immediate ?.
0 Ensure overlying ? is not present.

Early ? is important after an episode of gout.

Answer 4

fast
naproxen
diclofenac
colchicine
renal
CCF
CTx
aspiration
corticosteroid
secondary
microscopy
infection
mobilisation

Question 5

Long term management;

Hypouricaemic drug indications;
o ? attacks of gout .
o ? gout.
0 Evidence of ?/joint damage 
0 Associated ? disease .
0 Greatly elevated ? ? levels.

? is the drug of choice.
0 ? ? inhibitor, ? uric acid ?

Answer 5

recurent
tophaceous
bone
renal
uric acid
allopurinol
xanthine oxidase
reducing production

Question 6

Mx

The aim of treatment is to bring serum uric acid level into the ? ? of
the ? range.
The serum uric acid level should be measured every ?, and the dose
? in ?mg increments to a maximum of ?mg daily until uric acids are within this range (then ? monitoring).

Answer 6

lower half
normal
month
increased
100
900
yearly

Question 7

Mx

Treatment is only initiated after an acute attack has ?, usually after ?
weeks, so as not to ?/prolong the attack;
o The ? in tissue uric acid levels after initiation can partially ? MSUM crystals and trigger ? attacks.
o Concurrent ? given for a ?period for this reason.

Answer 7

settled
4 weeks
exacerbate
reduction
dissolve
acute
nsaids
short

Question 8

Mx

Lifestyle advice to reduce ?, total ?/? intake, and avoid
certain food groups (including offal, ? and spinach) is also important.

Other pharmacological options are ? drugs, e.g. ? or
sulfinpyrazone, which lead to increased ? of uric acid in the ?.
o Contraindicated in ? impairment, patients with a history of ?, or over-? of uric acid (excretion already high).

Answer 8

alcohol
calorie/cholesterol
fish
uricosuric
probenecid
excretion
urine
renal
urolithiasis
production