Gout & Pseudogout

Question 1

Uric acid is and end product of…… Metabolism

Answer 1

Purine

Question 2

A patient with a big toe swelling comes to clinic, biopsy of the swelling shows (needle-shaped crystals) appear brightly yellow under
polarized light microscopy (strongly birefringent),
What are these crystals?
What is the diagnosis?

Answer 2

Urate,
gout

Question 3

True or False
Asymptomatic hyperuricaemia does not require prophylactic
treatment

Answer 3

True

Question 4

MOA of Allupurinol

Answer 4

Xanthine oxidase inhibitors

Question 5

Treatment of acute Gout

Answer 5

Cold pack, Rest
• Anti-inflammatory
• Colchicine
o Inhibits intracellular microtubule formation
oGiven at regular intervals and not as per BNF
o Adverse effects - GI intolerance
• Short course of oral steroids
• Avoid Allopurinol ( competitive xanthine oxidase inhibitor) in acute gout as it will prolong attack or precipitate acute gout

Question 6

Treatment of Chronic Gout

Answer 6

. Hypouricemic drugs:
= Allopurinol (Renal clearance)
= Febuxostat (hepatic clearance)
. Uricosuric drugs

Question 7

66 yr old lady on Colchicine prophylaxis for chronic gout
• Background of renal impairment
• Admitted with community acquired pneumonia
• Allergic to penicillin – started another drug…
• Developed pancytopaenia

What is the drug that she started (knowing that she is already takimg Colchicine)?

Answer 7

Clarythromycin /Erythromycin

Question 8

Biopsy of a swelling in the big toe shows (Rhomboid-shaped) in blood-stained synovial fluid (weakly
birefringent)
What is the diagnosis

Answer 8

Calcium Pyrophosphate Dihydrate crystal
deposition Disease