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

Question 1

UW. Causes of gout? increased production 4

Answer 1

Primary gout (idiopathic)

Myeloproliferative/lymphoproliferative disorders

Tumor lysis syndrome

Hypoxantine guanine phosphorybosyl transferase deficiency

dar buvo pamineta psoriaze prie Q explanation

Question 2

UW. Causes of gout? decreased urate clearance 2

Answer 2

CKD
Thiazide/loop diuretics

Question 3

M. what presentation?

Answer 3

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

Question 4

M. classical case?

Answer 4

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

Question 5

UW. Risk factors? 3 main

Answer 5

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

Question 6

UW. what 3 things decr risk?

Answer 6

Dairy product intake

Vit C (>=1500 mg/d)

Coffee intake (>=6 cups/day)

Question 7

M. Patients need not have hyperuricemia to have gout.

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

Answer 7

.

Question 8

UW. DIagnosis gout 2

Answer 8

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)

Question 9

M. Tx for acute gout?

Answer 9

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

Question 10

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

Answer 10

colchicine

steroids were not listed for the same Q.

Question 11

M. Tx for acute gout.
If renal insuff?

Answer 11

corticosteroids

Question 12

M. Tx for chronic gout. ?

ie Tx between attacks to decr. recurrence

Answer 12

XANTINE INHIBITORS, ie allopurinol or febuxostat

Question 13

M. What DONT GIVE in acute?

Answer 13

XANTINE INHIBITORS, ie allopurinol or febuxostat

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

Question 14

M. Probenecid. what group?

Answer 14

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.

Question 15

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?

Answer 15

probenecid

Question 16

M. Tx for acute gout. 1st?

Answer 16

indometacin (nsaid)

Question 17

M. Tx for acute gout. 2nd?

Answer 17

oral corticosteroids

Question 18

M. Tx for acute gout. 3rd

Answer 18

cochicine

Question 19

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

Answer 19

.

Question 20

UW. in general gout management? 2

Answer 20

lifestyle modifications
drugs

Question 21

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

Answer 21

tophi formation
uric acid formation

Question 22

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

Answer 22

.

Question 23

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

Answer 23

.

Question 24

UW. tophus formation.
where occur?

Answer 24

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

Question 25

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

Answer 25

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

Question 26

UW. tophus formation. xray and aspiration?

Answer 26

xray - may show errosions of adjacent bone fluid - white, chalky material with high levels of MSU crystal visible on microscopy

Question 27

M. PSEUDOGOUT. what deposits?

Answer 27

Calcium pyrophosphate deposition disease

Question 28

M. PSEUDOGOUT. what seen under polorized light?

Answer 28

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

Question 29

M. PSEUDOGOUT. what are 2 biggest risk factors?

Answer 29

Hemochromatosis Primary hyperparathyroidism

Question 30

M. PSEUDOGOUT. what 2 cases USMLE will give?

Answer 30

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

Question 31

M. PSEUDOGOUT. Tx? acute

Answer 31

same as ,,regular" gout

Question 32

M. PSEUDOGOUT. Tx? chronic

Answer 32

treat underlying condition, since xantine oxidase inhibitors are clearly unnrelated

Question 33

M. PSEUDOGOUT. chronic. do we give xantine oxidase inhibitors?

Answer 33

NO

Question 34

UW. PSEUDOGOUT. symptoms?

Answer 34

Acute, mono or oligoarthritis Peripheral joints (knee most common)

Question 35

UW. PSEUDOGOUT. most common joint?

Answer 35

knee

Question 36

UW. PSEUDOGOUT. diagnosis?

Answer 36

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

Question 37

UW. PSEUDOGOUT. what seen on imaging?

Answer 37

Chondrocalcinosis on imaging

Question 38

UW. PSEUDOGOUT. Tx on UW?

Answer 38

mehlman = same as for gout UW: NSAIDS; intra-articular glucocorticoids, colchicine

Question 39

M. what is BPC? LY, but know if want 280 on step2

Answer 39

Basic calcium phosphate deposition disease.

Question 40

M. BPC presentation?

Answer 40

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

Question 41

UW table - prevention of future gout attacks

Answer 41

* 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

Question 42

UW. gout. Q. 2 mechanisms in general?

Answer 42

Overproduction or underexcretion of uric acid

Question 43

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

Answer 43

polycythemia vera (PV) Got acute gout + PV symptoms: headache, pruritus, hepatosplenomegaly

Question 44

UW. gout. Q. prevent?

Answer 44

allopurinol

Question 45

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

Answer 45

Incr. risk: red meat and sea food; Incr. risk: fructose, refined sugar; ALCOHOL. decr. risk: proteins from vegetarian food and low-fat dairy sources.

Question 46

UW. gout. Q. smoking and coffee?

Answer 46

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

Question 47

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

Answer 47

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

Question 48

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

Answer 48

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

Question 49

UW. acute gout. Q. what joint?

Answer 49

Sudden onset in 1st metatarsophalangeal joint = acute gout

Question 50

UW. chronic gout (tophaceous gout). joints?

Answer 50

multiple, hands, knees, feet

Question 51

UW. chronic tophi = nonpaiful acute = painful tophi

Answer 51

.

Question 52

UW pseudogout. Q. in what setting occurs? 3

Answer 52

recent surgery or medical illness. trauma/overuse

Question 53

UW pseudogout. Q. most common joint?

Answer 53

knee --> meniscal calcification (chondrocalcinosis)

Question 54

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

Answer 54

Fever and mild leukocytosis may occur in pseudogout. Not common in urate gout.

Question 55

UW pseudogout. Q. age onset?

Answer 55

>65

Question 56

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

Answer 56

monoarthritis affects knee and ankles

Question 57

UW pseudogout. in what systemic disease?

Answer 57

primary hyperparathyroidism (symptomatic hypercalcemia)