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STEP 2 dermal/MSK > Mehlman/UW gout + pseudogout 03-07 (3) > Flashcards

Mehlman/UW gout + pseudogout 03-07 (3) Flashcards

1
Q

UW. Causes of gout? increased production 4

A

Primary gout (idiopathic)

Myeloproliferative/lymphoproliferative disorders

Tumor lysis syndrome

Hypoxantine guanine phosphorybosyl transferase deficiency

dar buvo pamineta psoriaze prie Q explanation

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2
Q

UW. Causes of gout? decreased urate clearance 2

A

CKD
Thiazide/loop diuretics

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3
Q

M. what presentation?

A

arthritis of hands and knees + gouty torphi (monosodium urate crystal deposition)

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4
Q

M. classical case?

A

middle age guy + drinks alcohol + eats a lot of meat + drinks bags of nucleic acids

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5
Q

UW. Risk factors? 3 main

A

Medications: diuretics, loe dose aspirin

Diet: high protein diet (meat, seafood), high-fat food, sweetened beverage

Heavy alcohol consumption

kiti: AH, obesity, CKD, organ transplant

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6
Q

UW. what 3 things decr risk?

A

Dairy product intake

Vit C (>=1500 mg/d)

Coffee intake (>=6 cups/day)

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7
Q

M. Patients need not have hyperuricemia to have gout.

likewise, patient with hyperuricemia can be asymptomatic and not develop gout

A

.

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8
Q

UW. DIagnosis gout 2

A

a) X ray - normal in early
Punched-out erosions with an overhanding rim of cortical bone (rat bite lesion) in chronic gout

b) synovial fluid
- Inflammatory aspirate
- needle shaped negatively birefringent crystal (yellow = negative)

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9
Q

M. Tx for acute gout?

A

1st INDOMETHACIN (nsaid)
then
2nd oral corticosteroids
then
3rd Colchicine

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10
Q

M. Tx for acute gout.
If alergy to nsaids?

A

colchicine

steroids were not listed for the same Q.

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11
Q

M. Tx for acute gout.
If renal insuff?

A

corticosteroids

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12
Q

M. Tx for chronic gout. ?

ie Tx between attacks to decr. recurrence

A

XANTINE INHIBITORS, ie allopurinol or febuxostat

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13
Q

M. What DONT GIVE in acute?

A

XANTINE INHIBITORS, ie allopurinol or febuxostat

they are used only in chronic. in acute they can worsen flares

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14
Q

M. Probenecid. what group?

A

it inhibits organic anion transporter (OAT) in the kidney, which both inhibits reabsorption of uric acid AND secretion of beta-lactams –> therefore can be used TO MAINTAIN beta-lactam levels in serum.

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15
Q

it inhibits organic anion transporter (OAT) in the kidney, which both inhibits reabsorption of uric acid AND secretion of beta-lactams –> therefore can be used TO MAINTAIN beta-lactam levels in serum.
what drug?

A

probenecid

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16
Q

M. Tx for acute gout. 1st?

A

indometacin (nsaid)

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17
Q

M. Tx for acute gout. 2nd?

A

oral corticosteroids

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18
Q

M. Tx for acute gout. 3rd

A

cochicine

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19
Q

M. Dont give probenecid to patients with Hx or urolithiasis (due to drug causing increased excretion of uric acid within renal tubules)

A

.

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20
Q

UW. in general gout management? 2

A

lifestyle modifications
drugs

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21
Q

UW. gout. what is ,,complicated disease”?

A

tophi formation
uric acid formation

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22
Q

M. Gout. Crystals, causing urolithiasis are radiolucent on xray.

A

.

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23
Q

UW. tophus formation.
Persistent hyperuricemia –> chronic gout with tophi formation

24
Q

UW. tophus formation.
where occur?

A

Painless cutaneous lesions, commonly occuring over:
Joints of hands and feet (most common)
Helix of ears
Olecranon bursa

25
Q

UW. tophus formation.
what deposits? in general info?

A

Excessive monosodium urate (uric acid) deposition in joints or soft tissue –> chronic inflammation and nodular deformities of the affected tissue

Can cause ulcers

26
Q

UW. tophus formation.
xray and aspiration?

A

xray - may show errosions of adjacent bone

fluid - white, chalky material with high levels of MSU crystal visible on microscopy

27
Q

M. PSEUDOGOUT.
what deposits?

A

Calcium pyrophosphate deposition disease

28
Q

M. PSEUDOGOUT. what seen under polorized light?

A

rhomboid-shape blue (POSITIVELY birefringent) crystals under polarized light.

29
Q

M. PSEUDOGOUT.
what are 2 biggest risk factors?

A

Hemochromatosis
Primary hyperparathyroidism

30
Q

M. PSEUDOGOUT.
what 2 cases USMLE will give?

A
  1. Monoarthritis of large joint
  2. Osteoarthritis-like presentation of hands in sb with hemochromatosis or primary hyperparathyroidism
31
Q

M. PSEUDOGOUT.
Tx? acute

A

same as ,,regular” gout

32
Q

M. PSEUDOGOUT.
Tx? chronic

A

treat underlying condition, since xantine oxidase inhibitors are clearly unnrelated

33
Q

M. PSEUDOGOUT. chronic.

do we give xantine oxidase inhibitors?

34
Q

UW. PSEUDOGOUT. symptoms?

A

Acute, mono or oligoarthritis

Peripheral joints (knee most common)

35
Q

UW. PSEUDOGOUT. most common joint?

36
Q

UW. PSEUDOGOUT. diagnosis?

A

Inflammatory effusions (15-30k cells)
CPPD crystals (blue = positive birefringence)
Chondrocalcinosis on imaging

37
Q

UW. PSEUDOGOUT. what seen on imaging?

A

Chondrocalcinosis on imaging

38
Q

UW. PSEUDOGOUT. Tx on UW?

A

mehlman = same as for gout

UW: NSAIDS; intra-articular glucocorticoids, colchicine

39
Q

M. what is BPC?

LY, but know if want 280 on step2

A

Basic calcium phosphate deposition disease.

40
Q

M. BPC presentation?

A

presents as Milwaukee shoulder, which is a cold (non-inflammatory) effusion of the shoulder

41
Q

UW table - prevention of future gout attacks

A
  • Weight loss to achieve BMI <25 kg/m2
  • Low-fat diet
  • Decreased seafood & red meat intake
  • Protein intake preferably from vegetable & low-fat dairy products
  • Avoidance of organ-rich foods (eg, liver & sweetbreads)
  • Avoidance of beer & distilled spirits
  • Avoidance of diuretics when possible
42
Q

UW. gout. Q. 2 mechanisms in general?

A

Overproduction or underexcretion of uric acid

43
Q

UW. gout. Q. what myeloproliferative was in case?

A

polycythemia vera (PV)

Got acute gout + PV symptoms: headache, pruritus, hepatosplenomegaly

44
Q

UW. gout. Q. prevent?

A

allopurinol

45
Q

UW. gout. Q. risk factors –> need lifestyle modifications. What incr. and decr. risk of attack? foods, drinks

A

Incr. risk: red meat and sea food;

Incr. risk: fructose, refined sugar; ALCOHOL.

decr. risk: proteins from vegetarian food and low-fat dairy sources.

46
Q

UW. gout. Q. smoking and coffee?

A

Smoking and coffee (not tea) => decr. risk of podagra

47
Q

UW. gout. Q. what drugs incr. risk?

A

Thiazides, loop diuretics, aspirin, BAB => incr. risk of gouty attack.

48
Q

UW. gout. Q. what drugs decr. risk?

A

Losartan and CCB, atorvastatin and rosuvastatin => lower uric acid => reduce risk.

49
Q

UW. acute gout. Q. what joint?

A

Sudden onset in 1st metatarsophalangeal joint = acute gout

50
Q

UW. chronic gout (tophaceous gout). joints?

A

multiple, hands, knees, feet

51
Q

UW. chronic tophi = nonpaiful
acute = painful tophi

52
Q

UW pseudogout. Q. in what setting occurs? 3

A

recent surgery or medical illness.
trauma/overuse

53
Q

UW pseudogout. Q. most common joint?

A

knee –> meniscal calcification (chondrocalcinosis)

54
Q

UW pseudogout. Q. general symptoms versus in acute gout?

A

Fever and mild leukocytosis may occur in pseudogout.

Not common in urate gout.

55
Q

UW pseudogout. Q. age onset?

56
Q

UW pseudogout. Q. how many joints? what joints?

A

monoarthritis

affects knee and ankles

57
Q

UW pseudogout. in what systemic disease?

A

primary hyperparathyroidism (symptomatic hypercalcemia)

STEP 2 dermal/MSK (33 decks)

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