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Organ Systems- Rheum > Gout- P > Flashcards

Gout- P Flashcards

1
Q

Uric acid is the breakdown product of _______ and therefore depends directly on both _______ and ______..

A

purine production and purine intake

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2
Q

The balance between ________ and ______ determines the serum urate levels.

A

production and excretion

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3
Q

In individuals with high serum urate levels, how might urate be deposited?

A

Either occultly or in the form of appreciable masses (tophi)

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4
Q

T or F. Underexcreors have a normal rate of exretion.

A

True

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5
Q

______ play a central role in the exretion of urate by the kidney.

A

OATs

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6
Q

Normally, uric acid is completely broken down by _____.

A

bacteria in the colon

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7
Q

What 2 mutations are known to cause increase in uric acid?

A

LOF of HGPRT (also causes Lesch-Nyhan)

GOF of PRPP

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8
Q

T of F Dehydration can trigger gout attack

A

T

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9
Q

T or F MI promotes hyperuricemis.

A

T

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10
Q

What drugs promote hyperuricemia?

A

Diuretics (loop and thiazides)

Drugs in the treatment of TB like ethambutol and pyrazinamide

Salicylates, nicotininc acids, cyclosporing, ethanol, CSF

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11
Q

What does fructose do to uric acid levels?

A

It turns up xanthine production–> raises levels

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12
Q

T or F. After the first gouty attack, gout tends to come back asymmetrically in multiple joints, which can make it easy to confuse with RA.

A

True

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13
Q

What are the uric acid nephrolithiasis risk factors?

A
  1. increase uric acid excretion
  2. Decrease urine volume
  3. decrease urine pH

All of these –> uric acid as insoluble acid

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14
Q

What will WBC count be in gouty attack?

A

High, 95% neutrophils

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15
Q

Propagation of acute gouty response is activated by ______.

A

neutrophils

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16
Q

What happens with neutrophils when crystals are coated with Ig?

A

results in activation and release of inflammatory mediators like IL-1, IL-8, and TNF as well as ROS

17
Q

What immunologically happens when crystals are not coated?

A

Cell lysis

18
Q

T or F. Gouty attack triggers explosive increase in LTB4.

A

True

19
Q

Individuals who are hyperuricemic should be screened for what?

A

hypertension, CAD, diabetes, obesity, alcoholism

20
Q

When do serum uric acid levels increase in men and women?

A

men- puberty

Women- menopause

21
Q

What is the highest incidence age of gout? What does this mean when compared to age of increasing levels of uric acid?

A

Men: 30-45

Women 55-70

The means there is a lengthy asymptomatic phase

22
Q

What does estrogen therapy do for uric acid?

A

decreases the rise in menopausal women

23
Q

Certain foods clearly promote hyperuricemia and gout. This includes _____.

A

ALcohol (beer), seafood, red meat

24
Q

T or F. Rare forms of early hyperuricemia and gout have a clear genetic and metobolic basis.

A

T

25
Q

What are the stages of gout?

A

Asymptomatic hyperuricemia

Acute and intercritical gout

chronic gouty arthritis

26
Q

The DDx for acute gout is usually _____.

A

Infectious arthritis or other crystal induced synovitis like pseudogout

27
Q

What conditions are associated with gout?

A

obesity, hypertriglyceridemia, glucose intolerance, metabolic syndrome, hypertension, atherosclerosis, hypothyroidism, renal insufficiency, nephrolithiasis, tumor lysis syndrome, alcohol use, lead intox, cyclosporine

28
Q

In untreated gout, what is the prevalence of nephrolithiasis?

A

20%

29
Q

What are the 3 mutations of renal disease associated with gout?

A

FJHN, MCKD 1, MCKD 2

30
Q

Secondary hyperucicemia and gout are usually related to ________.

A

decreased renal urate clearance

31
Q

What should you do to the dose of allopurinol in renal insuffieciency?

A

Decrease!!! Dose is based on Creatinine clearance

32
Q
A

Organ Systems- Rheum (10 decks)

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