Crystal arthropathies

Question 1

if you suspect gout, what is the top differential

why

Answer 1

septic arthritis

presents similar but more serious

Question 2

is gout more common in males or females

Answer 2

males (9:1)

Question 3

what are the modifiable risk factors of gout (2)

Answer 3

diet - red meat, shellfish, cheese

alcohol

Question 4

what is the general pathophysiology of gout

Answer 4

increase in urate acid crystals (hyperuricaemia)

Question 5

aetiology of gout associated with over production of urate crystals (2 + examples)

Answer 5

genetics

high cell turnover - cancer, psoriasis, infection, excessive exercise

Question 6

which skin condition is associated with gout

Answer 6

psoriasis

bc of high cell turnover

Question 7

aetiology of gout associated with underexcretion of urate crystals (4)

Answer 7

thiazide diuretics
metabolic issues
renal failure!
starvation

Question 8

in gout why are the urate crystals deposited in the joints

Answer 8

colder temp than other parts of body

Question 9

in gout what happens when the crystals are deposited in the joints

Answer 9

inflammation of joint

Question 10

what type of crystals are associated with gout

Answer 10

urate crystals

Question 11

triggers for gout flare up (3)

Answer 11

dehydration
trauma
surgery

Question 12

common locations of gout (3)

Answer 12

1st MTP joint (big toe)!!!!
ankle
knee

Question 13

how many joints does gout usually involve

name of this

Answer 13

one

monoarthritic

Question 14

presentation of gout (3)

when (2)

Answer 14

red
hot 
severe pain 
rapid onset (hours/overnight)
lasts <2 weeks

Question 15

investigations of gout (4)

Answer 15

joint aspiration
inflammatory markers
blood tests
blood cultures

Question 16

what is the gold standard investigation for gout

Answer 16

joint aspiration

Question 17

findings of joint aspiration of gout (2)

Answer 17

negative birefringent

needle shaped crystals

Question 18

why do you need to do a blood test/culture for gout

Answer 18

to rule out septic arthritis

Question 19

management of gout acute flare up (7)

Answer 19

expose, cool, elevate
antiinflammatory - NSAIDs, colchicine (if NSAID not tolerated), corticosteroids
analgesia

Question 20

first line prophylaxis of gout flare up (after an acute attack)

Answer 20

allopurinol

Question 21

lifestyle modification for gout (4)

Answer 21

reduce red meat
reduce shellfish
reduce alcohol
loose weight

Question 22

what drug would you consider changing if someone was on it and had a gout acute attack

Answer 22

thiazide diuretics

Question 23

who do you give gout prophylaxis to

Answer 23

> 2 flare ups in 6 months

Question 24

does gout present on xray

Answer 24

acute attack - no

chronic gout - yes (erosions)

Question 25

when do you give gout prophylaxis (in relation to the attack)

Answer 25

2-4 weeks after acute attack (when flare up has settled)

Question 26

what is the mechanism of allopurinol

Answer 26

reduces uric acid production

Question 27

for gout do you start allopurinol for gout high dose or low dose why

Answer 27

low dose lowering uric acid too quickly can cause another acute gout attack

Question 28

what is an alternative uric acid lowering drug to allopurinol

Answer 28

febuxostat

Question 29

complications of gout

Answer 29

``` chronic gout (polyarticular chronic joint inflammation) kidney stones ```

Question 30

how can gout result in kidney stones

Answer 30

urate crystals can be deposited in kidney tubules

Question 31

what is the differential list for someone with monoarthritic joint pain

Answer 31

``` septic arthritis gout pseudogout enteropathic arthritis (IBD) reactive arthritis ```

Question 32

what type of crystals are deposited in pseudogout

Answer 32

calcium pyrophosphate crystals

Question 33

which group of people are more likely to get pseudogout

Answer 33

elderly

Question 34

which other MSK condition is pseudogout closely associated with

Answer 34

osteoarthritis

Question 35

which joints does pseudogout usually affect

Answer 35

knees wrists ankles

Question 36

gold standard investigations for pseudogout

Answer 36

joint aspiration

Question 37

result of joint aspiration in pseudogout (2)

Answer 37

positive birefringence | rectangular/rhomboid/envelope shaped crystals

Question 38

whats can differentiate between gout and pseudogout

Answer 38

joint aspiration

Question 39

is there inflammation in gout

Answer 39

yes

Question 40

is there inflammation in pseudogout

Answer 40

no

Question 41

treatment of pseudogout

Answer 41

NSAIDs colchicine (if NSAIDs not tolerated) steroids

Question 42

prophylaxis of pseudogout

Answer 42

none :(

Question 43

what is hydroxyapatite crystal deposition known as

Answer 43

Milwaukee shoulder

Question 44

where do hydroxyapatite crystals typically deposit

Answer 44

shoulder

Question 45

which group of people is Milwaukee shoulder common in

Answer 45

50-60 year old females

Question 46

investigations for Milwaukee shoulder

Answer 46

``` alizarin stain (red clumps of calcium) xray of shoulder (crystal deposits) ```

Question 47

presentation of Milwaukee shoulder

Answer 47

acute onset should pain | reduced range of movement

Question 48

renal failure | hot swollen joint

Answer 48

gout - decreased excretion of urate crystals

Question 49

rare complication of using allopurinol for gout why

Answer 49

acute gout attack - bc it lowers the serum uric acid