Gout- Sum

Question 1

SUL

Answer 1

4.0. -6.8

Question 2

> 6.8

Answer 2

Precipitation

Question 3

Other factors that may influence precipitation of crystals

Answer 3

Low pH
Low temp
Immune response

Question 4

Predisp to Gout

Answer 4

Obesity, 
Kidney prob
Inc protein diet, alcohol
Drugs
Genetics
CAD
Hypothyroidism

Question 5

Gout most commonly occur

Answer 5

1st MPJ

Question 6

Hyperuricemia

Answer 6

Overproduction (10%)

1- metab error
2- inc mitosis, inc DNA/RNA, inc purine

Question 7

Underexcretion (90%)

DEALT

Answer 7

1- hereditary renal tube pro

2- renal failure, drugs(thiazide diuretics, loop diuretics, EtOH, ASA)

Question 8

Stages of gout

Answer 8

Asymptomatic
Acute
Intercritical
Chronic

Question 9

Stages of gout

Asymptomatic

Answer 9

Inc urate SL w/o attack

Question 10

Stages of gout

Acute

Answer 10

Inflam, swelling, erosion,
No tophi
Painful
Sloughing skin

Question 11

Stages of gout

Intercritical

Answer 11

Time between attacks- 6m- 2yrs after 1st attack

Xray changes -erosive, periarticular calcification

Question 12

Stages of gout

Chronic

Answer 12

Painful all the time
Tophi w soft tissue swelling
Martel sign ,>5mm erosions
Soft and joint tissues attack ( joint space preserve)

Question 13

Gout diagnosis

Answer 13

Joint aspiration
Xray
Ultra sound
Labs-CBC, RF, uric acid

Question 14

Treatment(general)

W/in 24h of attack

Answer 14

Colchicine-1.2->(1 h later) 0.6 =1.8

Indomethacin (NSAID)- 50->(8h) 50; max 200

Corticosteroid - INtra, oral, IM, IV

ACTH -IM

Question 15

Treatment(prophyl)

Answer 15

Colchicine- 0.6 mg 1-2 tabs daily (until hyperurecemia, no attack for 3-6 m)

Question 16

Treatment (hyperuricemia control)

AX PUS Puk

Answer 16

Xanthine oxidase- allopurinol
Uricosuric agents- probenecid, sulfinpyrazone
Uricases- krystexxa, pegloticase (severe tophaceous gout)

Question 17

M>F

30 yrs, Avg 50yrs

Formation of uric acid in urate form w elevated levels; precipitation of urate into a crystallized form occurs

Answer 17

Gout