Gout Lupus

Question 1

Gout (hyperuricemia) etiology

Answer 1

↑ serum uric acid (purine byproduct),
causes monosodium urate (needle crystals)
90% M >30 yo

Question 2

Primary Gout etiology

Answer 2

Overprdxn: idiopathic

Question 3

Secondary Gout etiology

Answer 3

Underexcretion (most common):
renal insuff, DM, alcohol, diuretics

or

Overprdxn: diet (↑ purine), enz defect, malig, drugs/alcohol

Question 4

Gout presentation

Answer 4

Rapid onset
Severe pain, red, swell
Pain peaks 8-12hrs
(U) big toe
(U) recurrent

Question 5

Gout ↑ chance of developing what?

Answer 5

kidney (renal) stones by 1,000x

Question 6

Stage 1 Gout

Answer 6

asym hyperuricemia (does us know good to know this since there are no symptoms)

Question 7

Stage 2 Gout

Answer 7

acute gouty arthritis:

triggered by acute Δ in uric acid (alcohol, diet, meds)

Question 8

Stage 3 Gout

Answer 8

Intercritical gout:
comes and goes
same triggers

Question 9

Stage 4 Gout

Answer 9

chronic tophaceous gout

Question 10

Gout tests

Answer 10

Arthrocentesis for culture
Micro analysis = negatively birefringent crystals
X-ray = “rat bite” joint erosion

Question 11

Gout tx: Acute attack

Answer 11

NSAIDS (Indomethacin)
address trigger
Colchince for prevention

Question 12

Gout tx: Long term

Answer 12

Goal = ↓ uric acid stores
Overproducers: Allopurinol
Underexcreters: Probenecid, Allopurinol

Question 13

Gout tx: Prophylaxis

Answer 13

Uricosurics: colchicine, NSAIDS

Question 14

Pseudogout etiology

Answer 14

synovitis from
calcium pyrophospate dihydrate crystals (CPPD)
(P) enz hyperactivity, genetics
(U) >65, M=F

Question 15

Pseudogout associated w/

Answer 15

Trauma or
things that ↑ Ca2+:
hyperparathy
hypothy
hypophos
osteo

Question 16

Pseudogout presentation

Answer 16

Acute onset of erythema, pain, swell in LARGER joints (U) knees

Self-limiting

Question 17

Pseudogout X-Ray findings

Answer 17

Ca2+ crystal deposits:

• punctate, linear radiodensities in cartl, lig or capsules
• osteophytes

Question 18

Pseudogout labs

Answer 18

synovial fluid = postively birefringent crystals

no serum study available

Question 19

Pseudogout tx

Answer 19

tx underlying cause
↓ pain: NSAIDS, steroid inject, ice pack
prophylax: colchicine

Question 20

Systemic Lupus Erythematosus (SLE)

etiology

Answer 20

antibody/antigen complexes in tissues

P) genetic, viral, bacterial (we don’t know

Question 21

SLE pathiophysiology

Answer 21

autoanti to nuclear and cytoplasmic antigens destroy cells ->

chronic inflamm of:
skin, joints, kidney, lungs, NS, blood cells

Question 22

SLE epidemiology

Answer 22

F:M = 7:1
black F 4x more
(U) onset in 20s

Question 23

SLE presentation

Answer 23

Variable:
viral-type sxs
joint pain (U) PIP, MCP, wrist, knees
malar rash (butterfly) on nasolabial folds
discoid rash on sun-exp areas

Question 24

Need at least how many criteria from SLE chart for + diag?

Answer 24

4

Question 25

Classifications of SLE (4)

Answer 25

Classical = many criteria
Definite =  >=4
Probably = 3
Possible = 2

Question 26

Raynaud’s Phenomenon is?

Answer 26

finger tips turn white/blue
vasospastic disease
comes/goes
(P) indication of SLE

Question 27

SLE tests

Answer 27

tests are sensitive but not specific
Antinuclear antibody (ANA)
Erythrocyte Sedimentation Rate (ESR)

Question 28

SLE tx

Answer 28

By severity:
NSAIDS
Refer to rheum for: antimalarials, cortster

Question 29

Lupus Nephritis tx

Answer 29

cyclophosphamide

methylprednisone

Question 30

Tx for CNS involvement in SLE

Answer 30

antipsych, anticonvulsants

Question 31

Tx for Thrombosytopenia in SLE

Answer 31

corticosteroids

Question 32

Tx for Antiphospholipid Antibodies in SLE

Answer 32

anticoag w/ warfarin/heparin + asprin

Question 33

Drug-induced SLE epidemiology

Answer 33

drug-induced autoantibodies don’t necessarily result in SLE,
common in slow acetylators,
M=F, old white people

Question 34

Drug-induced SLE presents

Answer 34

viral-like sxs, joint pain

(U) taking new drug for >= 1mo

Question 35

Drug-induced SLE tests

Answer 35

positive ANTI-HISTONE antibodies

negative anti-dsDNA, anti-Sm

Question 36

Drug-induced SLE tx

Answer 36

stop offending drug

steroids

Question 37

Drug-induced SLE: most common offending drug

Answer 37

procainamide

Question 38

SLE prognosis

Answer 38

variable relapse/ remit
renal & CNS involvement = poor prog
infection causes ~30% of deaths
10yr survival >90%

Question 39

Sjogren’s Synd etiology

Answer 39

systemic auto-imm disorder
idiopathic or assoc’d w/ SLE or RA
results in chronic dyfxn of exocrine glands

Question 40

Sjogren’s Synd epidemiology

Answer 40

F:M = 9:1

(U) diag @ 40-50 yo

Question 41

Sjogren’s Synd presentation

Answer 41

sicca sxs (↓ tears, saliva) - sets this apart from SLE, RA
(P) other SLE/RA-like sxs

Question 42

Sjogren’s Synd tests

Answer 42

RF = +
ANA = +
CBC = (P) anemia of chronic disease

Question 43

Sjogren’s Synd tx

Answer 43

saliva and tear replacement drops

NSAIDS

Question 44

Scleroderma etiology

Answer 44

auto-imm disease thickening the skin,
F>M
onset 20-50 yo

Question 45

Systemic Sclerosis etiology

Answer 45

auto-imm disease thickening organs/connect tissue,
vascular Δs in small bv
F>M
onset 20-50 yo

Question 46

CREST is?

Answer 46

limited subtype of scleroderma/systemic sclerosis

Calcinosis cutis
Raynaud's
Esophageal ↓ motiility
Sclerodactyly
Telangestasia

Question 47

Diffuse scleroderma/systemic sclerosis

Answer 47

worse prognosis than CREST

same as CREST + trunk and proximal extremities

Question 48

Scleroderma/Systemic Sclerosis presentation

Answer 48

Polyarthralgias
Raynaud's
Pigment Δ
Dysphasia
Respiratory
Cardiac
Renal

Question 49

Scleroderma/Systemic Sclerosis tests

Answer 49

ANA = +

Anti-centromere antibodies (ACA)

Question 50

Scleroderma/Systemic Sclerosis tx

Answer 50

Raynaud’s: Ca2+ chan block
Esophageal: H2 block, proton pump inhib
Renal: ACE inhib