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Clin Med 4 > Gout, Raynaud's, Fibromyalgia > Flashcards

Gout, Raynaud's, Fibromyalgia Flashcards

1
Q

what does gout result from?

A

deposition of uric acid crystals in joints, tissues (tophi) and fluids w/in the body/joints

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2
Q

what is uric acid a metabolic product of?

A

metabolism of purines

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3
Q

is hyperuricemia the SAME as gout?

A

NO!!!

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4
Q

does asymptomatic hyperuricemia need to be treated?

A

NO!!!

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5
Q

whats the MOST COMMON arthropathy in the US?

A

Gout

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6
Q

what comorbidities is gout seen with?

A

obesity, HTN, DM, hyperlipidemia

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7
Q

gout can increase risk for having what?

A

MI

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8
Q

what is the biggest problem with gout?

A

underexcretion

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9
Q

causes of under excretion of uric acid?

A

genetics (primary hyperuricemia)

dehydration

renal disorders (renal insufficiency or decr GFR)

low dose ASA, thiazides, B-blockers, nicotinic acid

Lead nephropathy

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10
Q

non-modifiable risk factors of gout?

A

male, AA, advanced age, Pacific islanders

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11
Q

modifiable risk factor of gout?

A

alcohol and high purine food ingestion, obesity, HTN, diuretic use (HCTZ)

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12
Q

classic presentation of gout?

A

Podagra

-PAIN OUT OF PROPORTION IN BIG TOE (can’t walk or put sheet over it)

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13
Q

sx’s of gout

A
  • Podagra (Classic)
  • joint swelling (1 joint)
  • EXTREMELY TENDER
  • REDNESS
  • at night, awakens from sleep
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14
Q

what joints does gout occur in?

A

feet, ankles, knees

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15
Q

renal sx’s of gout?

A

uric acid stones, gouty nephritis (interstitial deposits)

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16
Q

PE of gout

A
  • monoarticular arthritis, TTP
  • skin warm, tense, dusky red
  • CHRONIC: TOPHI
  • Functional loss (Functio laesa)
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17
Q

dx of gout

A

ARTHROCENTESIS

NEGATIVE BIREFRINGENCE

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18
Q

what do you see on arthrocentesis that is DIAGNOSTIC for gout?

A

Intracellular uric acid crystals

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19
Q

24hour urine for underexcreters for gout will be what level?

A

normal level

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20
Q

24hour urine for overproducers for gout will be what level?

A

elevated level

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21
Q

what will be the uric acid level for someone with gout? is it diagnostic?

A

uric acid >6.8 (elevated)

NOT DIAGNOSTIC

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22
Q

4 categories for gout tx

A

anti-inflammatory for ACUTE ATTACK

anti-inflammatory PPX for prevention of recurrences

anti-hyperuricemia (urate-lowering) therapy for PREVENTION and REVERSAL OF THE CONSEQUENCES of rate crystal deposition

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23
Q

FIRST LINE tx for gout? when do you initiate therapy?

A

NSAIDs - initiate w/in 24hrs

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24
Q

which NSAID works best for gout?

A

Indomethacin

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25
Q

SECOND LINE tx for gout?

A

Colchicine

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26
Q

THIRD LINE tx for gout?

A

Corticosteroids (r/o infection first)

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27
Q

when do you start chronic tx for gout after an acute attack?

A

2-4 weeks after acute attack, start tx after recheck for uric acid level

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28
Q

what fruit reduces gout attacks?

A

cherries

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29
Q

what is pseudogout? more/less common than gout?

A

chondrocalcinosis

-less common than gout

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30
Q

deposition of what in pseudogout?

A

Ca pyrophosphate hydrate (CPPD) deposition

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31
Q

where does pseudogout mostly occur in the body? age?

A

knee

age >60 y/o

32
Q

pseudogout risk factors?

A

hypercalcemia

33
Q

sx’s of pseudogout?

A

acute, can be asx’s

MONOARTICULAR

can resolve on own

34
Q

pseudogout often co-exists with what disease?

35
Q

what sx is possible in pseudogout that ISN’T in gout?

36
Q

dx of pseudogout?

A

POSITIVE BIREFRINGENCE, rhomboid crystals

elevated ESR and CRP

37
Q

PE of pseudogout

A

red, warm, tender, swollen, asx’s

valgus deformity of knees highly suggestive of underlying CPPD

38
Q

what deformity is knees is highly suggestive of underlying CPPD?

A

valgus deformity

39
Q

dx criteria for CPPD?

A
  • CPPD crystals

- Synovial fluid CPPD crystal deposition

40
Q

what is DIAGNOSTIC for pseudogout?

A

radiographic findings of joint cartilage calcified and calcium deposits in joint spaces

41
Q

x-rays for pseudogout?

A

AP knee, AP pelvis, PA hands, PA wrist

42
Q

tx for acute pseudogout?

A

NSAIDs, colchicine (short-term), steroids (short-term), drain fluid, rest, ice

43
Q

definition of chronic pseudogout?

A

> 3 attacks/year

44
Q

FIRST LINE tx for chronic pseudogout?

A

colchicine is useful with frequent attacks

45
Q

SECOND LINE tx for chronic pseudogout?

46
Q

what is fibromyalgia?

A

chronic pain d/o

widespread pain and allodynia w/multiple tender points

47
Q

what is allodynia?

A

pain d/t a stimulus which doesn’t normally provoke pain

48
Q

fibromyalgia is NOT explained by___

Must r/o what first?

A

any other rheumatic or systemic d/o

MUST R/O OTHER D/O’S FIRST!!!

49
Q

what is fibromyalgia d/t?

A

increased response to stimulation from amplification or increased signaling in the CNS

CENTRAL SENSITIZATION

50
Q

what gender and age for fibromyalgia?

A

women 20-50

51
Q

pts with fibromyalgia have increased incidence of ___

A

depression, anxiety, HA, IBX, chronic fatigue syndrome, SLE, and RA

52
Q

what may trigger/activate fibromyalgia sx’s?

A

physical and/or emotional stressors

  • psychological trauma
  • psychological distress
  • sensitization of the pain system
53
Q

sx’s of fibromyalgia?

A

persistent widespread pain and abnormal tenderness, fatigue, sleep, and autonomic disturbances

54
Q

imaging for fibromyalgia? is it diagnostic?

A

NOT DIAGNOSTIC

MRI -> increased CNS activity that corresponds to FM subjective pain
-increased regional cerebral blood flow with response to pain

55
Q

describe fibromyalgia pain

A

widespread pain, multiple tender points

Moderate to severe intensity that fluctuates, worse in AM and before bed and with cold, stress, new exercise

56
Q

other sx’s of fibromyalgia besides pain?

A

fatigue or difficulty sleeping

hx of depression

psychological and neuropsych sx’s (anxiety, mental distress, cognitive dysfunction)

57
Q

fibromyalgia PE

A

tender muscles at 11 points

NO swelling, NO erythema

58
Q

fibromyalgia is a diagnosis of ___

59
Q

dx for fibromyalgia?

A

WBC, Anemia, Vit D level (for fatigue), TSH

Sleep study

Imaging (MRI, Radiographs)

60
Q

non-pharmacologic tx of fibromyalgia?

A

Cognitive behavior techniques
-helps with pain, coping skills, relaxation techniques

Exercise

  • based on tolerance, if pain then modify workout (DON’T STOP)
  • weight reduction w/nutrition counseling
61
Q

1ST LINE med tx for fibromyalgia?

A

Tylenol or Tramadol; or Tylenol+Tramadol (Ultracet)

62
Q

what meds should you NOT use to treat fibromyalgia?

A

narcotics or steroids

63
Q

2ND LINE med tx for fibromyalgia? careful with what for these?

A

TCAs (amitriptyline, nortriptyline)

-careful with them if they have a hx of depression b/c of suicidal ideations

64
Q

3RD LINE med tx fo fibromyalgia?

A

SNRIs (duloxetine)

SSRIs (fluoxetine, citalopram)

Cyclobenzaprine

Antiepileptics (Gabapentin)

65
Q

which meds for fibromyalgia have the best efficacy with fibromyalgia?

66
Q

what is Raynaud’s phenomenon precipitated by?

A

cold exposure or stress

67
Q

which Raynaud’s (primary or secondary) is associated with a cause?

A

Secondary Raynaud’s

68
Q

Raynaud’s is common with people with what diseases?

A

connective tissue diseases (I.e. scleroderma)

69
Q

what is CREST syndrome?

A

Calcinosis, Raynaud’s phenomenon, Esophageal Dysmotility, Sclerodactyly and Telangiectasia

70
Q

what drug may cause Raynaud’s?

A

beta-blockers

71
Q

PE of Primary Raynaud’s?

A

normal b/w attacks

72
Q

PE of Secondary Raynaud’s?

A

pits or ulcerations on the fingertips may be present in pt’s with scleroderma, CREST syndrome or thromboangiitis obliterans

73
Q

dx of Raynaud’s

A

based on pts description of attacks

in primary Raynaud’s vasospastic attacks are precipitated by exposure to cold or emotional stimuli and there is BILATERAL involvement of extremities w/out gangrene

74
Q

tx for Raynaud’s

A

mild attacks - reassurance for the pt and how to prevent attacks

mittens better than gloves

AVOID SMOKING B/C VASCOCONSTRICTOR

BB’s may exaggerate sx’s

75
Q

what is the MOST EFFECTIVE med for tx of Raynaud’s?

A

CCB’s (amlodipine and nifedipine)

Clin Med 4 (11 decks)

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