quesmed

Question 1

how does acute gout present

Answer 1

arthritis of the 1st MTP joint

sudden, severe attacks of pain, swelling and redness and tenderness in the joints

often the joint at base of big toe

asymmetric

tachycardia

Question 2

what causes gout

Answer 2

precipitation of uric acid crystals within the joint leading to an acute inflammatory response

Question 3

what is gout

Answer 3

a form of arthritis caused by the deposition of monosodium urate crystals in and around the joints

Question 4

what is the 1st investigation for suspected gout

Answer 4

arthrocentesis - need to rule out septic arthritis (sent away for gram stain)

the synovial fluid will then be analysed (microscopy , culture and sensitivity)

Question 5

how to tell gout from pseudo gout

Answer 5

needle shaped monosodium urate crystals with negative birefringence confirm gout

Question 6

first line treatment for gout

Answer 6

NSAID - indomethacin

Question 7

what is first line treatment for gout when patient has a GI high risk, PMH of kidney disease or HF ?

Answer 7

colchicine

Question 8

what can be used to treat acute gout

Answer 8

NSAIDs, colchicine, steroids and paracetamol

Question 9

lifestyle changes to manage gout

Answer 9

reduction of alcohol
reduction of purine based food (meat and seafood)

Question 10

when is it appropriate to start allopurinol

Answer 10

commences at a low dose at least 2 weeks following an attack

used when:
more than 2/3 attacks a year
tophaceous gout
x-ray changes show chronic destructive joint disease
urate nephrolithiasis

Question 11

scoring system for RA

Answer 11

das-28

Question 12

what must you screen for before putting a patient on a biologic ?

Answer 12

TB