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academic weapon > MS1: Gout and SLE > Flashcards

MS1: Gout and SLE Flashcards

1
Q

what is gout

A

associated w hyperuricemia caused by deposition of monosodium urate crystals or MSU

inflammatory arthritis - group 2

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2
Q

discuss primary gout

A

due to inherited inborn error ng purine metabolism kaya mag kaka hyperuricemia

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3
Q

discuss secondary gout

A

from another disease or from the therapy of it

associated w neoplasm, renal disease, diabetes, hyperlipidemia or metabolic disorders

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4
Q

how does hyperuricemia cause gout

A

excess uric acid in blood forms crystals that collects joint = painful inflammatory response

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5
Q

what are the stages of classic gout

A

asymptomatic hyperuricemia

acute intermittent gout

advanced gout

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6
Q

discuss asymptomatic hyperuricemia

A

pag more than 2 standard dev na

female: > 6 mg/dL
male: > 7 mg/dL

so positive bloodwork but wala pa symptoms

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7
Q

when does acute intermittent gout occur

A

men: 40-60 yo
women: menopause

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8
Q

presentations of acute intermittent gout

A

sudden warmth, swelling, erythema and pain of joint - 4 cardinal signs

monoarticular tas sa 1st MTP - podagra

systemic symptoms - fever, chills and malaise

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9
Q

other possible joints affected by gout

A

midfoot, ankle, heel and knee - LE

less common sa UE - wrist, finger and elbow

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10
Q

discuss acute intermittent stage

A

sa early stages episodes are not as frequent mga years pero evetually it becomes more frequent, longer and more joints

may mga intercritical period

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11
Q

what is intercritical period

A

period where nawala yung symtoms but may MSU crystals padin sa synovial fluid

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12
Q

when is it considered advanced gout

A

pag more than 10 yrs na ng acute intermittent gout

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13
Q

discuss advanced gout

A

aka chronic tophaceous gout - may tophi or parang nodules

associated w:
early onset
untreated gout - 4 attacks per yr

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14
Q

where are subcutaneous tophi commonly found

A

fingers
wrist
ears
knees olecranon
pressure points

also pwede s kidney, heat and sclerae

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15
Q

discuss the pathogensis of gout

A

either may overproduction or underexcretion ng MSU

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16
Q

causes of overproduction of MSU

A

inherited enzyme defect

malignancy, psoriasis and obesity

drugs and food rich in purine

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17
Q

causes of underexcretion of MSU

A

renal problems, dehydration, salt restriction
hypertension
hyperthyroid or hypo
diabetes

ethanol, diuretics, laxative

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18
Q

SSx of gout

A

acute monoarticular arthritis - asymmetric

magising from pain and pressure from clothes in masakit

redness and swelling

low grade fever and chills

pwede mag resolve - masama sa blood

90% sa 1st MTP

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19
Q

how to differentiate heberdens from gout

A

gout is read and whitish tas pag inopen may crystals

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20
Q

other sites of initial gout

A

instep
ankle
heel
knee
wrist

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21
Q

what makes chronic gout a chronic gout

A

may tophi sa bone or skin

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22
Q

discuss tophi

A

higher serum rate = more tophi deposited

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23
Q

typical locations of tophi

A

ear
elbow
finger

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24
Q

discuss diagnosis process for gout

A

has swelling, pain or tenderness in joint or bursa > MSU + = gout

paf naman MSU negative proceed to criteria

if wala swelling pain or tenderness or meron pero sa lumbar or shoulder = not gout

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25
Q

discuss gout classification criteria - patter of joint/bursa involvement

A

0 - other than ankle, midfoot of 1st MTP
1 - ankle or midfoot
2 - MTP1

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26
Q

discuss gout classification criteria - symptomatic episodes

A

erythema, cant bear touch or difficulty in walking/use joint

0 - none
1 - one
2 - two
3 - three

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27
Q

discuss gout classification criteria - time course of episode

A

0 - no episodes
1 - one
2 - recurrent

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28
Q

discuss gout classification criteria - tophus

A

0 - absent
4 - present

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29
Q

discuss gout classification criteria - lab findinfs

A

basta pag more than 6 mg/dL nag kaka score na

nag nnegative score if negative findings

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30
Q

discuss gout classification criteria - imaging

A

4 - evidence of urate deposition
4 - gout related damge

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31
Q

discuss imaging for gout

A

preferred ang CT scan over xray kase di kita sa xray and uric crystals

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32
Q

risk factors of gout

A

hyperuricemia
alcohol
high meat and seafood intake
CANT LEAP drugs
obesity
hypertension

33
Q

what is CANT LEAP

A

drug risk factors for gout

cyclosporine
alcohol
nicotine
thiazides
lasix
ethambutol
aspirin if low dose
pyrazinamide

34
Q

discuss septic arthritis DD from gout

A

septic:
no sex predication
group 3 synovial - infectious milky white
high grade fever
antibiotic treatment
knee or shoulder - uncommon ang MTP1

35
Q

discuss other crystal arthropathies DD from gout

A

need gram stain and cultures

36
Q

medications to lower uric acid level

A

xanthine oxidase inhibitors - allopurinol, febuxostat and uricase

probenecid - inc excretion

high dose aspirin

37
Q

medications for gout pain

A

NSAIDS
steroids
colchicine

38
Q

what is pseudogout

A

cause by calcium pyrophosphate dihydrate crystals or CPPD

39
Q

pseudogout is usually associated w ______

A

trauma, amyloidosis, myxedema, hyperthyroid, gout and hemochromastosis

40
Q

pathophysio of pseudogout

A

degenerative and often severe but can be asymptomatic

intermittent attacks of acute

xray shows calcified cartilage

41
Q

where does pseudogout usually occur in the popu

A

equal gender tas > 60 yo.

42
Q

SSx of pseudogout

A

acute arthritis in larger joints - knee

follows pattern of gout but less severe

may chondrocalcinosis sa xray

trapezoid shaped crystals

43
Q

identify if gout or pseudogout

middle aged men and postmenopausal women

A

gout

44
Q

identify if gout or pseudogout

elderly and equal sex distribution

A

pseudogout

45
Q

identify if gout or pseudogout

mono - small joints and LE

A

gout

46
Q

identify if gout or pseudogout

mono/poly of UE or LE

A

pseudogout

47
Q

identify if gout or pseudogout

acute arthritis is frequent

A

both

48
Q

identify if gout or pseudogout

MSU needle shaped

A

gout

49
Q

identify if gout or pseudogout

CPP rhomboid shaped

A

pseudogout

50
Q

identify if gout or pseudogout

alcohol, trauma, excess meat/fish, medication, stress

A

gout

51
Q

identify if gout or pseudogout

stress and trauma

A

pseudogout

52
Q

what is calcific tendinitis DD from gout and pseudo gout

A

hydroxyapatite and crystals tas elderly

53
Q

SLE is more common in what gender

A

female

54
Q

what is SLE

A

autoimmune attack on multi systems

55
Q

discuss lab screening for SLE - CBC

A

look for anemia, leukopenia and throbocytopenia

56
Q

discuss lab screening for SLE - ESR

A

can be elevated

57
Q

discuss lab screening for SLE - urinalysis

A

proteinuria, hematuria or + casts

58
Q

discuss lab screening for SLE - ANA and anti-dsDNA/SM

A

if postive edi may autoimmune/lupus

59
Q

what are the criteria for SLE

A

DOPAMIN RASH

discoid rash
oral ulcer
photosensitivity
arthritis
malar rash
immunologic disorder
neurologic disorder
renal disorder
antinuclear antibody
serositis
hematologic

4/11

60
Q

discuss discoid rash

A

red raised cricular patches tas pwd mag scar sa older

61
Q

discuss oral ulcers

A

oral or nasopharyngeal tas painless

62
Q

discuss photosensitivity

A

skin rash due to sunlight

63
Q

discuss arthritis SLE

A

affects fingers and wrist but non erosive

64
Q

discuss malar rash

A

butterfly rash over nose

65
Q

discuss neurologic disorder

A

any - seizures, psychosis mga ganun

66
Q

discuss renal disorders

A

most dreaded - persistent proteinuria

67
Q

discuss antinuclear antibody

A

+ = SLE

68
Q

discuss serositis

A

inflammation

lungs - pneumonia
heart - pericardial effusion
GI - stomach erosion

69
Q

RA vs SLE cause

A

RA - autoimmune
SLE - autoimmune

70
Q

RA vs SLE gender

A

both female

71
Q

RA vs SLE symptoms

A

RA - arthritis is erosive and symmetrical, rashes
SLE - arthritis is non erosive and non symmetrical, rashes is malar or discoid, ulcer

72
Q

RA vs SLE photosensitivity

A

meron SLE

73
Q

RA vs SLE severity

A

RA - less
SLE - more

74
Q

non pharmacol treatment of SLE

A

avoid precipitants, sunblock

75
Q

cutaneous treatment for SLE

A

avoid sun, sunblock, topical steroids

76
Q

MSK treatment for SLE

A

NSAIDs, predsinone

77
Q

renal treatment for SLE

A

Diffuse proliferative glomerulonephritis, high dose steroids, IV cyclophosphamide

78
Q

cardiopulmo treatment for SLE

A

NSAID and steroids

79
Q

hematologic and neurologic treatment for SLE

A

mga IV eme eme

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