28. Gout Flashcards Preview

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Flashcards in 28. Gout Deck (30)
1

gout is more common in ( sex)

males

2

gout is an ( definition )

acute inflammatory monoarthritis caused by precipitation of monosodium urate crstals in joints

3

gout is an ... caused by ...

acute inflammatory monoarthritis
precipitation of monosodium urate crystals in joints

4

gout is associated with

hyperuricemia

5

hyperuricemia can be caused by ( name the mechanism and the proportions )

1. underexcretion of uric acid (90%)
2. overproduction of uric acid ( 10%)

6

hyperuricemia - causes of underexcretion of uric acid

1. idiopathic ( largely )
2. medications ( eg. thiazide diuretics, pyrazinamide )
3. Renal insufficiency

7

hyperuricemia - causes of overproduction of uric acid

1. Lesch - Nychan syndrome
2. PRPP excess
3. increased cells turnover ( eg. tumor lysis syndrome )
4. Von Gierke syndrome

8

von Gierke syndrome - deficiency of

Glucose -6 - phosphatase

9

Gout - crystals

monosodium urate crystals

10

monosodium urate crystals - characteristics

1. needle shaped
2. (-) birefringent under polarized light
3. blue under perpendicular light
4. yellow under paraller light

11

gout - presentation of the joint

1. swollen
2. red
3. painful
4. Asymmetric joint distribution

12

gout clinical presentation and classic manifestation

asymmetric joint distribution swollen, red , painful joint
painful MTP joint of big toe ( podagra )
Tophus formation

13

Tophus formation - area

1. external ear
2. olecreanon bursa ( elbow )
3. Achilles tendon

14

tophi ?

white, chalky aggregates of uric acid crystals

15

Acute gout attack tends to occur ...

after meal and alcohol consumption

16

meal can cause acute gout - mechanism

increased DNA/ RNA

17

alcohol consumption can cause acute gout - mechanism

alcohol metabolites compete the same exertion sites in kidney as uric acid --> decreased uric acid secretion

18

gout treatment

acute --> 1.nsaid ( eg. indomethacin ) 2. colchicine 3. glucorticoids
Chronic ( preventive) --> xanthine oxidase inhibitors

19

treatment of acute gout

1.nsaid ( eg. indomethacin ) 2. colchicine 3. glucorticoids

20

treatment of chronic gout ( prevention )

xanthine oxidase inhibitors
1. allopurinol
2. febuxostat

21

• Gout occurs from the precipitation of this crystal in joint spaces.

Monosodium urate

22

• A 56-year-old man with a history of gout is given a new antihypertensive agent, which causes a gout attack. What drug was likely started?

A thiazide diuretic (blocks excretion of uric acid and increases the likelihood of having a gout flare)

23

• A patient has swollen, red, painful joints. They appear to be associated with gout. Will they appear in a symmetric or asymmetric pattern?

Asymmetric

24

• Gout crystals are ____ (positively/negatively) birefringent and ____ (needle/rhomboid) shaped, appearing ____ in color under parallel light.

Negatively; needle; yellow (yellow under parallel light)

25

• Is gout more common in men or women?

Men

26

• Alcohol use and large meals can exacerbate what joint disease? Why?

Gout; alcohol and other metabolites from the meal compete with uric acid for excretion sites in kidney, causing reduced secretion

27

• A 55-year-old man who drinks on a daily basis presents with a red, swollen toe. What is the acute management of this patient's disease?

NSAIDs (e.g., indomethacin), glucocorticoids, or colchicine (this patient has gout)

28

• Name four metabolic diseases/conditions that predispose a patient to gout.

Lesch-Nyhan syndrome, PRPP excess, increased cell turnover (e.g., in tumor lysis syndrome), and von Gierke disease

29

• Gout is a problem of uric acid buildup. Do the majority of cases involve overproduction or underexcretion?

90% involve underexcretion, and 10% involve overproduction

30

• What is podagra?

A painful, swollen MTP joint of the big toe, classically seen in acute gout flares

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