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Y4 Acute Care > Gout > Flashcards

Gout Flashcards

1
Q

What is Gout? (2 points)

A
  1. Type of Crystal arthropathy
  2. Associated w Chronically high Uric acid levels in blood
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2
Q

What is the pathophysiology of Gout? (5 steps)

A
  1. Increased Uric acid prod / Decreased excretion
  2. Raised serum Uric acid
  3. Deposition of Urate crystals in joints
  4. Inflamm response
  5. Gout flare
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3
Q

What joints does Gout typically affect? (3 things)

A
  1. First MTP (big toe) (70%)
  2. Wrists
  3. Base of thumb (carpometacarpal joints)
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4
Q

What are the RF for Gout? (8 things)

A
  1. Age
  2. Male
  3. Obesity
  4. High purine diet (aka meat / sea food)
  5. Alcohol
  6. Diuretics
  7. CVS / Kidney disease
  8. FHx
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5
Q

What age does first Gout attack usually happen?

A

Between 30-50 yrs

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6
Q

When does a Woman’s risk of Gout increase?

A

After Menopause

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7
Q

How does the Onset / Offset of Gout differ it from other types of Arthritis? (2 things)

A
  1. Develops very rapidly, n reaches Max severity within 24 hours
  2. Resolves within 1-2 weeks
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8
Q

What are the CF of a joint of Gout? (3 things)

A
  1. Intense stabbing pain (touching it will hurt) (stops dem from sleeping)
  2. Erythema (red + warm)
  3. Reduced ROM (bc tender + swollen)
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9
Q

What does the Erythematous joint of Gout resemble?

A

Cellulitis

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10
Q

What is the Dx of Gout based on?

A

Clinically (CF + Hx)

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11
Q

If Dx can’t be done clinically, what investigation can you do to confirm Dx of Gout?

A

Synovial fluid aspiration

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12
Q

What will Synovial fluid aspiration show in Gout? (4 things)

A
  1. No BAC growth
  2. Needle shaped crystals
  3. Negatively birefringent of Polarised light
  4. Monosodium Urate Crystals
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13
Q

What investigation should you do for CHRONIC Gout? (2 things)

A
  1. XR
  2. US
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14
Q

What will you see in an X-Ray of Chronic Gout? (4 things)

A
  1. Joint space MAINTAINED
  2. Lytic lesions in bone
  3. “Punched out” erosions
  4. Sclerotic borders w Overhanging edges on Erosions
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15
Q

What will you see on an US of Chronic Gout?

A

Tophi (will appear white)

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16
Q

What is the most important DDx to rule out in Gout?

A

Septic Arthritis

17
Q

What would make you think Septic Arthritis is likely in sus Gout? (2 things)

A
  1. Systemically unwell + Joint CF
  2. RF: IVDU
18
Q

How can you rule out Septic Arthritis in sus Gout?

A

Refer immediately for Joint Aspiration + Culture

19
Q

What are some other DDx that present similarly to Gout? (3 things)

A
  1. Pseudogout
  2. Cellulitis
  3. RA
20
Q

How can you differentiate between Gout n Pseudogout? (4 things)

A

Pseudogout:
1. Affects larger joint (aka Knee)
2. More likely in Elderly
3. LESS intense pain
4. Chondrocalcinosis on XR

21
Q

How can you definitely determine it’s Pseudogout n not Gout?

A

Synovial fluid aspiration
(will show Rhomboid shaped Positively birefringent Calcium Pyrophosphate crystals)

22
Q

How can you differentiate between RA and Gout? (3 things)

A

RA will have:
1. GRADUAL onset of pain
2. Rheumatoid nodules present (but easily confused w Gout Tophi)
3. LESS recurrent flares

23
Q

What markers are the Same / Different in RA + Gout? (2 things)

A
  • RF: Can be present in both
  • Anti-CCP: More specific to RA (but low sensitivity)
24
Q

What investigation can you do to definitively determine it’s not Gout, n more likely RA?

A

Synovial fluid aspiration
(won’t show Urate crystals if not Gout)

25
Q

What are the Mx options for an ACUTE flare up of Gout? (First – Third line)

A
  1. FIRST LINE: NSAIDs (ibuprofen)
  2. SECOND LINE: Colchicine
  3. THIRD LINE: Steroids
    (NCS)
26
Q

When is Colchicine used instead of NSAIDs in Acute Gout flare up? (2 things)

A

When NSAIDs inapprop:
1. Renal impairment
2. Significant heart disease

27
Q

What is a very common Side fx of Colchicine?

A

Diarrhoea

28
Q

What is used Long Term for Gout Prophylaxis?

A

Allopurinol

29
Q

What class of meds if Allopurinol?

A

Xanthine oxidase inhibitor

30
Q

What is the basic MOA of Allopurinol?

A

Reduces Uric acid levels

31
Q

What is important to know about prescribing Allopurinol?

A

Don’t prescribe it until AFTER acute attack has settled

32
Q

What are some lifestyle changes you should advice for Gout Prophylaxis? (4 things)

A
  1. Weight Loss
  2. Hydration
  3. X Alcohol
  4. X Purine-based foods (meat / sea food)
33
Q

Finished

A

سُبْحَانَ اللَّهِ وَبِحَمْدِهِ

Y4 Acute Care (31 decks)

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