Weekly Check Point - Gout Flashcards
Which one of the following imaging findings is most characteristic of gout on ultrasound?
A. Osteophytes and joint space narrowing
B. Subchondral cysts and sclerosis
C. “Double-contour” sign – hyperechoic, irregular line of MSU crystals on the surface of articular cartilage
D. Diffuse synovial thickening with increased vascularity
C. “Double-contour” sign – hyperechoic, irregular line of MSU crystals on the surface of articular cartilage
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The “double-contour” sign is a classic ultrasound finding in gout, representing monosodium urate (MSU) crystals deposited on the surface of articular cartilage. This is a key diagnostic feature that distinguishes gout from other forms of arthritis, such as osteoarthritis or rheumatoid arthritis, which may present with osteophytes, joint space narrowing, or synovial thickening.
A 55-year-old male presents with acute monoarticular arthritis of the first metatarsophalangeal joint (podagra).
Which of the following is the gold standard for diagnosing gout?
A. X-ray imaging showing joint erosions
B. Ultrasound showing tophi
C. Joint aspiration with synovial fluid examination for negatively birefringent crystals
D. Serum uric acid level
C. Joint aspiration with synovial fluid examination for negatively birefringent crystals
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The gold standard for diagnosing gout is joint aspiration with synovial fluid analysis, which reveals negatively birefringent needle-shaped monosodium urate (MSU) crystals under polarized light. While serum uric acid levels, imaging, and clinical presentation are supportive, they are not definitive for diagnosis.
A patient with chronic tophaceous gout is found to have urate nephropathy and renal stones. Which one of the following urate-lowering therapies (ULT) is contraindicated in this patient?
A. Allopurinol
B. Pegloticase
C. Febuxostat
D. Probenecid
D. Probenecid
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Probenecid, a uricosuric agent, is contraindicated in patients with urolithiasis (renal stones) and severe renal impairment because it increases urinary excretion of uric acid, which can exacerbate stone formation and renal complications. Allopurinol, febuxostat, and pegloticase are alternative options that do not have this contraindication.
A 60-year-old female with chronic gout and a history of recurrent acute attacks is started on a urate-lowering therapy. She develops another acute attack shortly after starting the new medication. Which drug should be used to manage this acute attack while continuing the urate-lowering therapy?
Colchicine
A 58-year-old female with chronic gout and a history of asthma is started on a urate-lowering therapy. Which drug should be avoided due to its potential to exacerbate asthma?
Indomethacin
A 45-year-old male presents with an acute gouty attack in his right big toe. He has no history of peptic ulcer disease or renal impairment. Which drug is most appropriate for immediate pain relief and inflammation control?
Indomethacin
A 62-year-old male with chronic gout and a history of gastric ulcers is started on a urate-lowering therapy. Which drug should be avoided due to its potential to worsen gastric ulcers?
Indomethacin
A 50-year-old male with chronic gout and a history of peptic ulcer disease presents with an acute gouty attack. Which drug is most appropriate for managing his acute pain while minimizing gastrointestinal side effects?
Corticosteroids
A 60-year-old male with congestive cardiac failure (CCF) is being treated with thiazide diuretics. He presents with elevated serum uric acid levels.
Which one of the following is the most likely mechanism of hyperuricemia in this patient?
A. Decreased intestinal excretion of uric acid
B. Increased uric acid production due to myeloproliferative disease
C. Increased production of uric acid due to excessive dietary purine intake
D. Decreased renal excretion of uric acid due to thiazide diuretics
D. Decreased renal excretion of uric acid due to thiazide diuretics
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Thiazide diuretics are known to cause hyperuricemia by decreasing the renal excretion of uric acid. They promote uric acid reabsorption in the proximal tubule, leading to elevated serum uric acid levels. This is a common side effect of thiazide diuretics, especially in patients with conditions like congestive cardiac failure.
A 45-year-old male presents with recurrent episodes of acute arthritis and is found to have elevated serum uric acid levels.
Which one of the following laboratory findings would be most specific for diagnosing gout?
A. Elevated serum uric acid level (>7 mg/dL)
B. Presence of negatively birefringent needle-shaped crystals in synovial fluid
C. Low urine pH (<5.5)
D. Increased fractional excretion of uric acid (FEUA)
B. Presence of negatively birefringent needle-shaped crystals in synovial fluid
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The gold standard for diagnosing gout is the identification of negatively birefringent needle-shaped monosodium urate (MSU) crystals in synovial fluid under polarized light microscopy. While elevated serum uric acid levels are common in gout, they are not specific, as hyperuricemia can occur without gout. Similarly, FEUA and urine pH are not diagnostic for gout.
Which one of the following is the gold standard for diagnosing gout?
A. Serum uric acid level
B. Joint aspiration with synovial fluid examination
C. Ultrasound imaging
D. X-ray imaging
B. Joint aspiration with synovial fluid examination
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The gold standard for diagnosing gout is joint aspiration with synovial fluid examination, which allows for the identification of negatively birefringent needle-shaped monosodium urate (MSU) crystals under polarized light microscopy. While serum uric acid levels and imaging (X-ray, ultrasound) can support the diagnosis, they are not definitive.
A 55-year-old male with a history of hypertension and chronic kidney disease presents with sudden onset of severe pain and swelling in his first metatarsophalangeal joint.
Which one of the following medications is most likely contributing to his condition?
A. Thiazide diuretics
B. Lisinopril
C. Metformin
D. Metoprolol
A. Thiazide diuretics
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Thiazide diuretics are known to inhibit tubular urate secretion, leading to hyperuricemia and increasing the risk of gout. This patient’s comorbidities (hypertension and chronic kidney disease) and the presentation of acute monoarthritis are consistent with gout.
Which one of the following lifestyle modifications is most likely to reduce the risk of gout in a patient with hyperuricemia?
A. Increased intake of sugary sodas and fruit juices
B. Increased consumption of red meat and seafood
C. Moderate consumption of low-fat dairy products
D. Reduced intake of coffee
C. Moderate consumption of low-fat dairy products
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Moderate intake of low-fat dairy products is associated with a reduced risk of gout. In contrast, increased consumption of red meat, seafood, and sugary sodas (high in fructose) are risk factors for hyperuricemia and gout. Coffee consumption, in moderation, is also associated with a reduced risk of gout.
Which one of the following is a common side effect of colchicine when used for the treatment of acute gout?
A. Hypertension
B. Diarrhoea
C. Hypokalaemia
D. Hyperglycaemia
B. Diarrhoea
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Colchicine, used for the treatment of acute gout, commonly causes gastrointestinal side effects, including diarrhoea. Other side effects may include abdominal cramps and, in severe cases, myelosuppression or liver toxicity. Hypertension, hyperglycaemia, and hypokalaemia are not typical side effects of colchicine.
