Crystal Disease - Told

Question 1

2 most common crystals

Answer 1

monosodium urate

calcium pyrophosphate dihydrate

Question 2

episodic attack

Answer 2

think crystals

Question 3

rare crystals

Answer 3

cholesterol
monoclonal proteins
calcium phosphate hydroxyapatite
calcium oxalate

Question 4

caicific tendonitis

Answer 4

with calcium phosphate hydroxyapatite

does not react on polarized light**

Question 5

oxalosis

Answer 5

kidney stops eliminating calcium oxalate from body
-get nephrolithiasis

get retinal sx as well

Question 6

terminal tuft calcification

Answer 6

with psoriatic arthritis and oxylosis only**

Question 7

multiple myeloma

Answer 7

monoclonal protein crystals in joints

S100A4 antibody**

MMP and apoptosis - matrix destruction of joint

Question 8

YIPA

Answer 8

yellow in parallel - monosodium urate

Question 9

BIPA

Answer 9

blue in parallel - calcium pyrophosphate

Question 10

hyperuricemia/gout epidemiology

Answer 10

increased with age and body mass

middle age men

incidence of gout in females approaches that of males after menopause

Question 11

risk with hyperuricemia

Answer 11

cardiovascular disease**

Question 12

hot joint

Answer 12

with gout

Question 13

decreased renal excretion

Answer 13

majority of hyperuricemia causes

impaired renal function
dehydration
acidosis
low dose salicylates
diuretic
pyrazinamide
cyclosporine
levodopa
ethambutol
nicotinic acid
hypothyroidism

Question 14

podagra

Answer 14

first attack of gout

Question 15

cytotoxic drugs

Answer 15

increase urate production - leads to hyperuricemia

Question 16

best predictor of gout attack

Answer 16

sudden change in uric acid level

Question 17

tophi

Answer 17

chronic urate overload

Question 18

negative birefringement

Answer 18

monosodium urate crystals

Question 19

clinical course of gout

Answer 19

1 - asymptomatic hyperuricemia
2 - intermittent arthritis
3 - chronic arthritis and acute exacerbations

Question 20

tophi

Answer 20

in gout

not just subQ
-can get into and destroy joint

Question 21

positive birefringement

Answer 21

BIPA
calcium pyrophosphate
pseudogout

Question 22

negative birefringement

Answer 22

YIPA
monosodium urate
gout

Question 23

indication for lowering of urate

Answer 23

tophi disease with erosions

uric acid nephrolithiasis

recurrent attack despite prophylaxis

Question 24

acute gout CI

Answer 24

allopurinol

but do not stop during attack if already taking**

Question 25

chondrocalcinosis

Answer 25

pseudogout

Question 26

calcium pyrophosphate deposition disease

Answer 26

CPPD - pseudogout

Question 27

associated with pseudogout

Answer 27

``` hyperPTH hypoT hemochromatosis wilsons disease OA ```

Question 28

management of crystal disease

Answer 28

arhrocentesis - analyze crystals NSAIDs corticosteroids colchicine - prophylaxis

Question 29

uric acid lowering agents

Answer 29

allopurinol febuxostate uricosuric agents not during acute attacks

Question 30

acute tx of gout

Answer 30

indomethacin

Question 31

tx of asymptomatic hyperuricemia

Answer 31

no tx - check diuretic use and ASA use and niacin use

Question 32

colchicine

Answer 32

can be crap shoot

Question 33

purine free diet

Answer 33

only decrease uric acid by 1%mg medication is best treatment**

Question 34

keratoconjunctivitis sicca

Answer 34

sjogrens disease | dry eyes and dry mouth

Question 35

primary sjogrens

Answer 35

women 40-60yo exocrine gland dysfunction RA and other auto-Abs common

Question 36

secondary sjogrens

Answer 36

with other autoimmune diseases

Question 37

diagnosis of sjogrens

Answer 37

4 of 6 criteria - sensitive 93% and specific 94% 1 - autoimmune exocrinopathy 2 - ocular sx 3 - oral sx 4 - ocular signs - schirmers or rose bengal 5 - characteristic histopath features 6 - salivary testing autoAbs - RF, SS-A, SS-B

Question 38

nucleolar anti Ro SSA

Answer 38

more specific than speckled**

Question 39

labs with sjogrens

Answer 39

anemia, leukopenia, eosinophilia hypergammaglobulinemia RA positive 70% ANA positive 95%

Question 40

sialectasis

Answer 40

cystic dilation of duct with sjogrens

Question 41

parotid gland enlargement

Answer 41

in sjogrens

Question 42

schirmers test

Answer 42

positive if cannot get tears in sjogrens wetting of 5mm/5min filter paper

Question 43

rose bengal staining

Answer 43

indicates inflammation and irritation of conjunctival layer of eyes positive in sjogrens

Question 44

nonspecific interstitial pneumonia and xyerotrachea

Answer 44

low tracheobronchial secretions - in sjogrens

Question 45

tx of sjogrens

Answer 45

tx is symptoms ``` artifical tears - methyl cellulose cyclosporine drops oral hygiene and hydration pilocarpine cevimeline ``` careful watch for lymphoma**