MSK CIS

Question 1

Increased uric acid levels are necessary for onset of gout, but not sufficient. What else must happen?

Answer 1

X linked mutation at URAT1 and GLUT9

Question 2

7 risk factors that can trigger gout

Answer 2

Alcohol, chronic renal insufficiency, chronic hyperuricemia, thiazides use, obesity, lead toxicity, systemic inflammatory response.

Question 3

What is a clinical sign or lab that can occur with gout and why?
6 medical conditions where there is a high prevalence of gout associated?

Answer 3

Elevated liver

HTN, CV disease, diabetes, renal disease, abnormal cholesterol, and systemic inflammatory response.

Question 4

2 things identifying gout for diagnostic purposes?

Answer 4

Presence of very tender, inflamed, swollen joint

Negatively birefringence needle shaped crystals in the joint

Question 5

What 4 other tests would you do while testing/evaluating for gout and why?

Answer 5

CXR to rule out TB, cardiomegaly and tophi in heart valves
ECHO because tophi can go over heart valves, so checking for murmur
EKG because gout is risk factor for CV disease
Culture and sensitive to rule out joint infection

Question 6

Concerning obstacles to treatment, consider the answers to the following questions?
Why would we pause before administering colchicine?
Why would we pause before administering prednisone?
What would we not give if we are treating HTN with gout?
When would beta blockers be contraindicated when treating gout?

Answer 6

Renal failure and HTN
Rule out septic joint and TB
Thiazides
COPD and diabetes

Question 7

What was the take home message from the end of the CIS for gout?

Answer 7

Medical comorbidity, hyperuricemia, and inadequate allopurinol use is associated with repeated unplanned hospitalization for gout.