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Clin Med IV Exam 1 > Gout, Psuedogout, FM, Raynaud > Flashcards

Gout, Psuedogout, FM, Raynaud Flashcards

1
Q

What is the pathophys of gout?

A

result of deposition of uric acid crystals in joint tissues and fluid within body/joints

hyperuricemia –> inflammtion –> destruciton

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2
Q

Is hyperuricemia the same as gout?

A

NO

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3
Q

Pt labs reveals hyperuricemia but is not experiencing any symptoms. Does this pt need to be treated?

A

NO

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4
Q

Non modifiable risk factors for gout

A

male
african america
adv age
pacific islander

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5
Q

Modifiable risk factors for gout

A 
Alcohol and high purine food ingestion
Obesity
HTN
Diuretic use--HCTZ
Toxic exposure--lead
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6
Q

What is the relation between GOUT and MI?

A

Gout can increase risk of MI

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7
Q

What pt population is gout most commonly seen in?

A

Men
Women after menopause
Pt w/ kidney dz

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8
Q

What comorbidities is gout strongly linked to

A

Obesity
HTN
Hyperlipidemia
DM

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9
Q

What are the 3 causes of gout?

A
  1. inherited (primary)
  2. acquired (secondary)
  3. unclear etiology
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10
Q

Do gout pt mostly present as overproducers or underexcreters?

A

Underexcreters

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11
Q

What are etiologies of underexcretion?

A

Causes increase level of uric acid in blood

  • primary hyperuricemia (genetic factors)
  • dehydration (acquired)
  • Renal insuff and decrease GFR (renal disorder)
  • Keto or lactic acidosis (endogenous)
  • Low dose ASA, thiazides, BB, nicotonic acid (exogenous)
  • Lead nephropathy
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12
Q

What are etiologies of over production?

A
  • Excessive dietary intake (red meat, organ meat, shellfish)
  • Alcoholic bevagerages (esp beer)
  • Leukemia
  • Hemolytic anemia
  • Psoriasis
  • Exercise (severe dehydration)
  • Fructose ingestion
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13
Q

Presentation of gout

A

Acute onset
Joint swellling usu in 1 joint, can be polyarticualr
Extremely tender
Redness
1/2 Podagra (MTP great toe)
Renal (uric acid stones, gouty nephritis)

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14
Q

What areas of the body is gout most likely to present

A

Feet
Ankles
Knee

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15
Q

Acute gout presents as…?

A

PODAGRA
monoarticular arthritis (can be polyarticular)
skin warm, tense, dusky red

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16
Q

Chronic gout presents as….?

A 
TOPHI
Deposits urate crystals
Drainage
CT destruction, gross deformity
Injection
bone destruction or erosion

FUNCTION LOSS

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17
Q

1 diagnostic tool for gout

A

Arthrocentesis

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18
Q

What should you be looking for in an arthrocentesis for gout?

A

Intra cellualr uric acid crystals

  • needle shaped
  • yellow when parallel
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19
Q

Are there birefringence under polarized light microscopy in a arthrocentesis of gout?

A

NO–negative

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20
Q

What other diagnostic tools should you get for gout

Hint: r/o septic joint

A

Gram stain and culture

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21
Q

24hr urine reveals increase level of uric acid. Is this pt a overproducer or underexcreter?

A

Overproducer

Underexcreters will have increase level of uric acid in the BLOOD

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22
Q

Should you rely on a increase serum uric acid >6.8 to diagnose gout?

A

No. can be misleading and not diagnostic

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23
Q

Acute gout Tx

A
  • diet modification
    1. NSAID
    2. Colchicine
    3. Corticosteroid
    4. Interleukin 1 beta inhibition (anakinra)
24
Q

How soon should you initiate acute gout tx?

A

within 24hrs

25
Q

How soon after an acute therapy should you start chronic tx?

A

2-4wks after acute attack

then recheck uric acid lvl

26
Q 
Which NSAID is best to tx gout?
A. naproxen
B. ibruprofen
C. diclofenac
D. indomethacin
A

D. Indomethacin

27
Q

Tachaceous deposits is a sign of what? (Chronic or acute?

A

Chronic gout

28
Q

Another name for psuedogout

A

Chrondocalcinosis

29
Q

What joint is psuedogout most commonly seen?

A

In the knee

30
Q

What is being deposited in psuedogout?

A

Ca++ pryophosphate dehydration (CPPD)

31
Q

Which of the following is not a risk factor for psuedogout?

A. age
B. diabetes
C. hyperparathyroidism
D. trauma

A

B. diabetes

32
Q

Presentation of psuedogout

A
  • acute
  • can be asymptomatic
  • mono or poly articular
  • can resolve on their own after few days or 2wks
  • often co-exist w/ osteoarthritis
  • FEVER POSSIBLE
  • red warm, tender, sweollen
  • VALGUS deformity of knee
33
Q

Diagnostic criteria of psuedogout

A

CPPD crystals
synovial fluid CPPD crystal deposits

elevated ESR/CRP

34
Q

Does psudogout have birefringents?

A

YES–positive

35
Q

What can you see on imaging for psuedogout?

A

Joint cartilage calcified and calcium deposits in joint spaces

Chondrocalcinosis

36
Q

Acute tx psuedogout

A 
NSAIDs
Colchicine
Steroids
Drain fluid
Rest
Ice
37
Q

What is considered chronic psuedogout

A

> 3 attacks per yr

38
Q

How would you tx chronic pseudogout?

A

1st Colchicine
2nd NSAID

Tx underlying condition if metabolic dz

39
Q

What does CREST syndrome stand for?

A 
Calcinosis
Raynaud
Esophageal dysmotility
Sclerodactyly (thickening of skin)
Telangiectasia
40
Q

Definition of Raynaud’s Phenomenon

A

Abrupt onset of well-demarcated pallor of digits which progresses to cyanosis w/ pain and often numbness–followed by reactive hyperemia on rewarming

41
Q

What can trigger Raynaud’s?

A 
Cold exposure
Stress
Use of BB 
Ergotamine preparation
Polyvinyl chloride
Some chemo agents 
Hand-arm vibration syndromes (vibratory tools)
42
Q

Primary Raynaud

A

Not assoc w/ any underlying cause

Physical exam normal between attacks

43
Q

Secondary Raynaud

A

Assoc w/ or caused by some other systemic illness or dz process (ex SLE)

Pits or ulcerations on fingertips may be present in pt w/ scleroderma, CREST syndrome, or thromboangiitis obliterans

44
Q

Does Raynaud present unilateral or bilaterally?

A

Bilaterally!

45
Q

What are the most effective pharmacologic agents to tx Raynaud

A

Dihydropyridine CCB (Amlodipine and NIfedipine)

46
Q

Non pharm therapies for Raynaud

A
  • use mittens instead of gloves
  • careful when handling cold objects
  • smoking cessation
  • avoid BB
47
Q

What is allodynia and what is it associated with?

A

Allodynia = pain d/t stimulus which does not normally provoke pain

Assoc w/ Fibromyalgia

48
Q

What pt population is fibromyalgia (FM) most commonly seen in?

A

Women age 20-50

49
Q

Presentation of FM

A
  • Widespread pain, multiple tender points
  • Worse in AM and before bed and w/ cold, stress and new exercises
  • stiffness
  • SENSATION of swelling
  • fatigue
  • difficulty sleeping
  • hx of DEPRESSION
  • psychological and neuropsych sx

NO swelling and NO erythema

50
Q

Dx criteria of FM

A

Generalized body pain for at least 3 mo

At least 11 out of 18 specific tender points

51
Q

What labs can you do to help you towards your dx of FM?

A

CBC–r/o infection
H&H–r/o anemia (cause of fatigue/joint point)
Vit D lvl r/o cause of fatigue
TSH–r/o hypo-T as cause of fatigue, malaise and arthralgia
Sleep Study

52
Q

What are the 1st line pharmacologic agents used for FM?

A

Tylenol or Tramadol

53
Q

2nd line pharm agents for FM?

A

Tricyclic Antidepressants

54
Q

What are non-pharm therapies for FM?

A
  • Cognitive behavior techniques
  • Exercise

Acupuncture
Massage
Chiropractic

55
Q

Should an pt newly diagnosed with FM stop exercising?

A

NO. If increased pain after exercise, modify work out–do not stop!

56
Q

A construction worker who often uses chain saws and pneumatic hammers presents with well-demarcated pallor of digits when exposed to cold. Based on the pt’s diagnosis, what therapy would be most effective for them?

A. Propanolol
B. Hydroxychloroquine
C. Nifedipine
D. Prednisone

A

C. Nifedipine

CCB work best (Amlodipine or Nifedipine)

BB may exaggerate sx

57
Q

What pharm therapy should you try 1st in a pt w/ newly diagnosed gout?

A

NSAID

*try colchicine 2nd

Clin Med IV Exam 1 (9 decks)

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