Mod 3-6 Gout

Question 1

Gout has links to what?

Answer 1

A person’s diet, but new medications have now allowed patients to have a more normal diet.

Question 2

What type of diet is good for a patient with gout?

Answer 2

A diet that is good for heart-health

Question 3

Who gets gout?

Answer 3

• Women after menopause
• More common in men (10:1)

Question 4

___ out of 1,000 men aged 18-44 have gout and ___ of 1,000 men aged 45-65.

Answer 4

2; 34

Question 5

How many new cases of gout are there a year in a population of 100,000 people?

Answer 5

30 new cases and 250 cases in total

Question 6

What is gout a type of?

Answer 6

Arthritis

Question 7

Define gout

Answer 7

An arthritic disorder in which uric acid appears in excessive quantities in the blood, called hyperuricemia, and may be deposited in crystalline form in various joints and in soft tissues.

*Disorder in the metabolism of purine in which an increase in teh blood level of uric acid leads to the deposition of uric acid crystals in the joints, cartilage and kidney.

Question 8

Why was gout once thought to be a “rich mans disease”?

Answer 8

Because obesity and alcoholism tend to influence the development of gout in those who have an inheritied trait for the disease. When the term was popular, only those with money would be a factor in the disease.

Question 9

What is the connection between food and drink and gout?

Answer 9

Uric acid is a waste product of metabolism.

Question 10

What are the two types of gout?

Answer 10

Primary and secondary

Question 11

Which type of gout is caused by an inherited tendency for overproduction of uric acid?

Answer 11

Primary gout

Question 12

What causes secondary gout?

Answer 12

• Enzyme imbalance caused by a disease (cancer)
• Nosocomial result of an attempt to treat a disease (hypertensive meds)
• Kidney failure
• Low doses of aspirin given for extended periods of time

Question 13

Why does kidney failure sometimes lead to gout?

Answer 13

The body’s level of uric acid increases because it cannot be eliminated in a normal and timely manner.

Question 14

Where are some sites of where uric acid may be deposited?

Answer 14

• Joints (feet, great toe, hands)
• Ear
• Olecranon bursa
• Insertion of Achilles tendon

Question 15

What is the most common site of where uric acid may be desposited?

Answer 15

The great toe

Question 16

What is the classic manifestation of the most common form of gout (secondary gout)?

Answer 16

Sudden onset of extreme joint pain.

Question 17

Which type of gout is most common?

Answer 17

Secondary gout

Question 18

In its acute stage, the arthritis usually attacks what?

Answer 18

A single joint; the great toe being the most commonly affected site.

Question 19

What part of the great toe is often affected by gout?

Answer 19

Metatarsophalangeal articulation

*Inflammation, may last 1-2 weeks

Question 20

Where in the joint is uric acid crystals deposited?

Answer 20

On the articular cartilage thus creating an inflammatory reaction

Question 21

The pain and inflammation may be severe enough to simulate what?

Answer 21

• A cellulitis (soft tissue inflammation)
• Produce fever
• Tachycardia
• Leukocytosis

Question 22

Severe attacks of gout may last as long as ________.

Answer 22

2 weeks.

Question 23

What is almost always present in those with gout?

Answer 23

Some degree of renal dysfunction

Question 24

Is renal dysfunction evident on radiographs?

Answer 24

No radiographic signs of renal dysfunction unless stones are created.

*If the stones have calcific nature, they can be seen radiographically; if no calcium is present they will be seen as a filling defect in the pelvis or ureter during an IVP. Stones may be radiolucent or radiopaque.

Question 25

How will gout produce radiographic evidence?

Answer 25

By repeated reoccurrence of such inflammatory processes. This will lead to radiographic evidence of gout. Usually late in the disease process.

Question 26

What are the earliest signs of gout?

Answer 26

Those produced by the inflammation; effusion and periarticular swelling at the affected joint.

Question 27

What do the urate crystals do to the bony surface?

Answer 27

The clumps of urate crystals on teh articular cartilage begin to erode any adjacent bony surface as the joint flexes with use.

Question 28

What are the crystal clumps called?

Answer 28

Tophi

Question 29

What do the crystal clumps (tophi) produce?

Answer 29

Small bony defects with sclerotic margins and overhanging edges tha thave been termed “rat bite” lesions.

Question 30

What is uncommon with tophi?

Answer 30

For it to be seen in more than one joint.

Question 31

When the tophi have a large concentration of _____ ____ they will be more visible. When the composition is low in ______, they will be much less visible.

Answer 31

calcium salts; calcium

Question 32

What does the density of tophi depend on?

Answer 32

According to its calcium composition

Question 33

Radiopaque tophi have ____ levels of calcium.

Answer 33

high

*Those with composition that does not include calcium will have a soft tissue density.

Question 34

What is the effect of radiotechnique with gout?

Answer 34

Advanced gout is considered destructive and therefore a decrease in kVp may be necessary. However, this may vary. Large tophi accumulations are hard to penetrate and may call for an increase in factors with non-digital equipment.