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(1) MS: Orthopedic and Rheumatic Conditions 🩺 > S3_L3: Gout > Flashcards

S3_L3: Gout Flashcards

1
Q

______ is a clinical disease associated with hyperuricemia and caused by deposition of monosodium urate (MSU) crystals.

A

Gout

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2
Q

The following statements are true about gout, EXCEPT:

A. Most common arthritis in males
B. Can be hereditary
C. Associated with an elevation in uric acid
D. Prevalent in the elderly
E. None of the above

A

NOTE: It is prevalent in the middle aged group

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3
Q

Differentiate primary and secondary gout.

A

Primary gout - manifestation of an inherited inborn error of purine metabolism characterized by an elevated serum uric acid (hyperuricemia)

Secondary gout - results from another disorder or due to its therapy

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4
Q

TRUE OR FALSE: Hyperuricemia is a serum urate level greater than 3 standard deviations above the mean value. The normal value for males is 6, while for females it is 7.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

B. Both statements are false

NOTE: greater than 2 SD; NV for the specific genders are interchanged.

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5
Q

The following statements are true about a gout attack, EXCEPT:

A. AKA acute intermittent gout
B. In men, usually first attacks between 4th and 6th decades
C. In women, onset is usually older, menopausal
D. most common affectation
is the 1st metacarpophalangeal joint known as podagra
E. None of the above

A

D. most common affectation
is the 1st metacarpophalangeal joint known as podagra

NOTE: It is the MTP, not MCP.

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6
Q

Match the following condition with its proper description.

  1. Equal sex distribution
  2. Rhomboid shaped crystal
  3. Chronic arthritis is common
  4. Middle aged men
  5. Elderly

A. Gout
B. Pseudogout
C. Both
D. Neither

A
  1. B
  2. B
  3. C
  4. A
  5. B
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7
Q

Match the following condition with its proper description.

  1. Precipitating event: surgical stress
  2. Precipitating event: trauma
  3. Affects upper and lower extremities
  4. Monosodium urate crystal
  5. Needle shape crystal

A. Gout
B. Pseudogout
C. Both
D. Neither

A
  1. C
  2. C
  3. B
  4. A
  5. A
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8
Q

TRUE OR FALSE: A crystal induced arthropathy is the only type of arthritic condition that is associated with food

A

True

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9
Q

When uric acid is not released, it starts to deposit. It’s more common in the (1)_______ because its farther from the (2)_______

A
  1. lower extremity (LE)
  2. heart
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10
Q

Excess uric acid in blood results in formation of (1)______ that collect in joints triggering a painful (2)_____

A
  1. uric acid crystals
  2. inflammatory response
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11
Q

TRUE OR FALSE: The longer a gout pt is affected, the more joints can be affected. The older a pt gets, the less frequent the attack is.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

C. Only the 1st statement is true

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12
Q

This is a period of which patient’s previously involved joints are free of symptoms but MSU crystals often can be identified in the synovial fluid

A

Intercritical period

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13
Q

Advanced gout is also known as?

A

chronic tophaceous gout

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14
Q

Advances gout develops after ___ or more years of acute intermittent gout

A

10

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15
Q

These are enlargement of the joints that look like swollen, bulbous growths just under your skin

A

Tophi (of gout)

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16
Q

Subcutaneous Tophi are commonly found in the following, EXCEPT:

A. ears
B. knees
C. olecranon
D. achilles tendon
E. armpits

A

E. armpits

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17
Q

In the advanced stage of chronic tophaceous gout, which organ must be checked regularly for potential damages?

A

Kidney

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18
Q

_______ is the end product of purine metabolism

A

Uric acid

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19
Q

TRUE OR FALSE: Gout arises from the lack of uricase and the solubility property of uric acid conditions humans to the deposition of urate from supersaturated body fluids.

A

True

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20
Q

What are the 2 causes of hyperuricemia?

A

Overproduction and Underexcretion

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21
Q

TRUE OR FALSE: Gout is the most painful arthritis.

A

True

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22
Q

Arrange the following structures that is most commonly the sites of initial involvement of gout. From most to least frequent, answer using the numbers only.

  1. Wrist
  2. Knee
  3. 1st MTP
  4. Ankle
  5. Instep
  6. Heel
A

354621

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23
Q

TRUE OR FALSE: Tophi produces acute inflammatory response and lead to acute gout arthritis then chronic arthritis. Tophi can erupt and discharge chalky masses of urate crystals.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is tru

A

A. Both statements are true

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24
Q

TRUE OR FALSE: A tophi is indirectly related to elevation of serum rate. Lower serum rate concentration, higher rate of deposition in soft tissue.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

B. Both statements are false

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25
Q

______ is defined as a draining or chalk-like subcutaneous nodule under transparent skin, often with overlying vascularity

A

Tophus

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26
Q

What are the 3 typical locations of a tophus?

A
  1. ear
  2. elbow (olecranon bursa)
  3. finger pulps
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27
Q

This is defined as serum urate level > 7 mg/dL in men and > 6 mg/dL in women and is the strongest risk factor for development of gout.

A

Hyperuricemia

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28
Q

TRUE OR FALSE: Wine consumption increases the risk of gout.

A

False

NOTE: It is beer.

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29
Q

High ________ content in beer also may contribute to hyperuricemia

A

purine guanosine

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30
Q

TRUE OR FALSE: Higher consumption of red meat products and seafood conferred a higher risk of hyperuricemia and incident gout

A

True

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31
Q

TRUE OR FALSE: High dairy intake is a protective factor for gout.

A

True

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32
Q

The following are drugs that can cause hyperuricemia due to decrease renal excretion, EXCEPT

A. Cyclosporine
B. Diazepam
C. Nicotinic acid
D. Thiazides
E. None

A

B. Diazepam

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33
Q

The following are drugs that can cause hyperuricemia due to decrease renal excretion, EXCEPT

A. Lasix
B. Ethambutol
C. Aspirin
D. Pyrazinamide
E. None

A

E. None

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34
Q

TRUE OR FALSE: Weight gain is strong risk factors for gout, while weight loss is protective

A

True

35
Q

TRUE OR FALSE: Hypertension is an established risk factor for gout

A

True

36
Q

This is a joint disease caused by deposition of calcium pyrophosphate dihydrate crystals

A

Pseudogout (false gout)

37
Q

The following is true about pseudogout, EXCEPT:

A. degenerative arthropathy
B. has intermittent attacks of acute arthritis
C. can be asymptomatic
D. MRI evidence of calcification of the articular cartilage
E. None

A

D. MRI evidence of calcification of the articular cartilage

NOTE: An X-ray detects this.

38
Q

In Pseudogout, the symptomatic disease usually appears in persons > ____ y/o

A

60

39
Q

TRUE OR FALSE: In Pseudogout, the cause is unknown. Both sexes are affected equally.

A. Both statements are true
B. Both statements are false
C. Only the 1st statement is true
D. Only the 2nd statement is true

A

A. Both statements are true

40
Q

Determine which clinical disorder result from the following crystal species.

  1. Acute gouty arthritis
  2. Chondrocalcinosis
  3. Calcific periarthritis
  4. Chronic gout arthritis
  5. Pseudogout

A. Hydroxyapatite
B. Calcium pyrophosphate
C. Monosodium urate

A
  1. C
  2. B
  3. A
  4. C
  5. B
41
Q

YES OR NO: Is a monosodium urate crystal common in the elderly?

A

No

42
Q

YES OR NO: Is a calcium pyrophosphate
crystal associated with osteoarthritis?

A

Yes

43
Q

YES OR NO: Is a hydroxyapatite
crystal common in the elderly?

A

Yes

44
Q

This is a group of noninfectious, inflammatory, erosive rheumatic diseases that target sacroiliac joints, bony insertions of the annulus fibrosus of the intervertebral disc and facet or apophyseal joints

A

Spondyloarthropathy

45
Q

What was Spondyloarthropathy
recently classified as?

A

Inflammatory back pain (IBP) or
Axial spondyloarthritis (SpA)

46
Q

The following are common features of Spondyloarthropathies:
1. _______ onset of each episode of backache
2. Family history of spondyloarthropathy
3. First episode of backache occurs before ____ years old
4. Each episode lasts for _____
5. Pain intensifies at ______

A
  1. Insidious
  2. 30
  3. months
  4. rest
47
Q

Is rheumatoid factor positive or negative in Spondyloarthropathy

A

negative

48
Q

The following are types of Spondyloarthropathy, EXCEPT:

A. Reactive arthritis
B. Ankylosing spondylitis
C. Psoriatic arthritis
D. Fibromyalgia
E. None

A

D. Fibromyalgia

49
Q

The following is true about Marie Strumpell disease, EXCEPT:

A. Acute progressive inflammatory disorder
B. Inflammation of the fibrous tissue affecting the entheses
C. Primarily affects the SI joint
D. More common in males
E. None

A

A. Acute progressive inflammatory disorder

NOTE: It is chronic

50
Q

This is one of the most common example of reactive arthritis. It refers to specific complex of organ pathology with typical extra-articular features within the larger group of patients with reactive arthritis.

A

Reiter’s syndrome

51
Q

Determine the condition.

  1. Common in males
  2. Equal sex predilection
  3. Presence of urethritis and conjunctivitis
  4. Symmetric changes by x-ray of sacroiliac joint
  5. Prominent involvement of peripheral joint

A. Ankylosing Spondylitis
B. Reiter’s Syndrome
C. Both
D. Neither

A
  1. C
  2. D
  3. B
  4. A
  5. B
52
Q

This refers to occurrence of acute, non-suppurative, sterile inflammatory arthropathy arising from an infectious process but at a site remote from the primary infection

A

Reactive Arthritis

53
Q

Calcium pyrophosphate dihydrate (CPPD) crystal deposits in pseudogout are secondary to (1)______ or (2)______ changes in the affected tissues

A
  1. degenerative
  2. metabolic
54
Q

Ankylosing Spondylitis is characterized by prominent (1)_____ of spinal joints and adjacent structures leading to progressive and ascending (2)______ of spine

A

1.inflammation
2. bony fusion

55
Q

______ is a complication of ankylosing spondylitis that’s caused by widespread fusing of the bones in the spine

A

Bamboo Spine

56
Q

In Ankylosing Spondylitis, what age group does it usually occur? Determine the peak age as well.

A

adolescence to age 35 (peak is 28)

57
Q

TRUE OR FALSE: Ankylosing Spondylitis may be hereditary.

A

True

NOTE: A familial predilection is seen, especially in those patients positive with HLA-B27

58
Q

Ankylosing Spondylitis characterized by ______ spinal inflammation

A. Ascending
B. Descending

A

A. Ascending

59
Q

Determine if the following presentations in Ankylosing Spondylitis is skeletal or extraskeletal.

  1. Cauda equina syndrome
  2. Arthritis of “girdle joints”
  3. Sacroiliitis
  4. Amyloidosis
  5. Acute anterior uveitis

A. Skeletal
B. Extraskeletal

A
  1. B
  2. A
  3. A
  4. B
  5. B
60
Q

The following is true about Ankylosing Spondylitis, EXCEPT:

A. Decreased mobility in anteroposterior and lateral planes will be symmetric
B. Stiffness for more than 3 months usually worse in the morning, lasting more than 1 hour
C. + Schober’s test
D. Earliest feature seen on X-ray is kyphosis
E. None

A

D. Earliest feature seen on X-ray is kyphosis

NOTE: Earliest feature seen on X-ray is sacroiliitis

61
Q

What are the 3 complications that may arise from Ankylosing Spondylitis?

A
  1. Fracture (common in cervical spine)
  2. Osteoporosis
  3. Pseudoarthrosis (common in thoracolumbar spine)
62
Q

The following are Radiologic findings in Ankylosing Spondylitis:

  1. Presence of existing _______
  2. _______ deformity
A
  1. syndesmophyte
  2. Bamboo spine
63
Q

The following is true about Ankylosing Spondylitis, EXCEPT:

A. Sacroiliac joint is rarely tender on palpation
B. Loss of lumbar lordosis
C. Paravertebral muscle spasm, aching and stiffness are common
D. In severe cases, spine becomes fused
E. None

A

E. None

64
Q

The following is true about laboratory findings of Ankylosing Spondylitis, EXCEPT:

A. (+) HLA-B27
B. Elevated ESR
C. Serum IgA elevated
D. (+) RF and ANA
E. None

A

D. (+) RF and ANA

65
Q

What comprises the triad in Reiter’s disease?

A

Conjunctivitis, urethritis and arthritis

66
Q

Both Reiter’s Syndrome and Reactive Arthritis are pathogenically related by virtue of their documented or presumed (1)______ onset which is followed by persistent (2)_____ and occurs in individuals inheriting HLA-B27.

A
  1. postinfectious
  2. inflammation
67
Q

The following is true about Reiter Syndrome, EXCEPT:

A. Triggered by infection and occurs 1 to 4 days the onset infection
B. Presents with asymmetric oligoarthritis often affecting the large joints
C. Common between ages 20 and 40 with peak during the third decade
D. Men more affected than women
E. None

A

A. Triggered by infection and occurs 1 to 4 days the onset infection

NOTE: It happens after 1-4 weeks

68
Q

TRUE OR FALSE: Post-venereal Reiter’s syndrome is more common in males while post-dysenteric Reiter’s syndrome affects men and women equally

A

True

69
Q

The following is true about Psoriatic Arthritis, EXCEPT:

A. Acute, recurrent, erosive, inflammatory arthritis
B. Equal sex predilection
C. Associated with skin disease psoriasis
D. Lesions are non itchy
E. None

A

A. Acute, recurrent, erosive, inflammatory arthritis associated with skin disease psoriasis

NOTE: It is chronic

70
Q

Psoriatic Arthritis is a distinct disease that combines features of both (1)_____ and (2)_______

A
  1. RA
  2. spondyloarthropathies
71
Q

Determine the condition.

  1. No skin lesion
  2. Common in males
  3. More symptom of inflammatory back and neck pain
  4. Grade IV sacroiliitis
  5. Ankylosing is due to syndesmophytes arise in the lateral and anterior surface of the bodies

A. Psoriatic Arthritis
B. Ankylosing Spondylitis

A
  1. B
  2. B
  3. B
  4. B
  5. A
72
Q

The following is true about Psoriatic Arthritis, EXCEPT:

A. Skin lesions are piles of well defined, dry, erythematosus often overlapping silver scaled papules and plaques
B. Men tend to develop symmetric polyarthritis and spinal involvement
C. Occurs at any age but usual between 20 and 30 years
D. Cause is unknown
E. None

A

B. Men tend to develop symmetric polyarthritis and spinal involvement

NOTE: Women tend to develop it more.

73
Q

The following is true about the s/sx of Psoriatic Arthritis, EXCEPT:

A. Pain and stiffness in the inflamed joint
B. Pain aggravated by prolonged immobility and reduced by rest
C. Morning stiffness that lasts more than 30 years
D. Can later affect the MCP and MTP
E. None

A

E. None

74
Q

Psoriatic arthritis usually joints of the fingers, specifically the (1)_____, and the (2)______ and (3)______

A
  1. DIP
  2. spine
  3. sacroiliac joint
75
Q

It is a marked diffuse swelling of the whole finger, causing typical sausage digit because of the extension of inflammation to the tendon sheath of adjacent joints. This occurs in more than ⅓ of PsA.

A. Dactylitis
B. Nail lesion
C. Uveitis
D. Conjunctivitis

A

A. Dactylitis

76
Q

This is a multiple pinpoint bleeding in px with Psoriasis.

A. Auspitz sign
B. Koebner’s response

A

A. Auspitz sign

77
Q

This is the appearance of new skin lesions of a pre-existing dermatosis on areas of cutaneous injury in otherwise healthy skin.

A. Auspitz sign
B. Koebner’s response

A

B. Koebner’s response

78
Q

This deformity found in PsA is referred to as the cupping of proximal portion of phalanges

A

pencil in cup deformity

79
Q

This is a chronic inflammatory disease affecting the GIT that may be due to genetic predisposition , environmental factors, or
alterations in the function of the immune system.

A

Inflammatory Bowel Disease

80
Q

What are the 2 major types of Inflammatory Bowel Disease?

A
  1. Crohn’s disease (CD)
  2. Ulcerative Colitis (UC)
81
Q

Determine which statement is true about Inflammatory Bowel Disease.

A. Ulcerative Colitis more common in men
B. Crohn’s disease more common in men
C. Peak incidence:45-65 y/o
D. Common in Asians
E. None

A

B. Crohn’s disease more common in men

NOTE: Peak incidence is between 15-35 years old. It is more common in people with Caucasian and Jewish background. Ulcerative Colitis more common in women.

82
Q

Determine the condition.

  1. More prominent bloody diarrhea
  2. More indolent and chronic
  3. More acute flares
  4. Tender Right Lower Quadrant (RLQ) mass
  5. Rectal pain

A. Ulcerative Colitis
B. Crohn’s Disease

A
  1. A
  2. B
  3. A
  4. B
  5. A
83
Q

Determine which extraintestinal manifestations of IBD is more common in its subtypes.

  1. Erythema nodosum
  2. Ankylosing spondylitis
  3. Aphthous ulcer

A. Ulcerative Colitis
B. Crohn’s Disease

A
  1. B
  2. A
  3. B
84
Q

Determine which extraintestinal manifestations of IBD is more common in its subtypes.

  1. Cholangitis
  2. Aphthous ulcer
  3. Secondary amyloidosis leading to renal failure

A. Ulcerative Colitis
B. Crohn’s Disease

A
  1. A
  2. B
  3. B

(1) MS: Orthopedic and Rheumatic Conditions 🩺 (13 decks)

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