Degenerative & crystal-induced arthropathies (obj 19)

Question 1

__% of all people have radiographic features of osteroarthritis in weight-bearing joints by age __.

Answer 1

90% of all people have radiographic features of osteoarthritis in weight-bearing joints by age 40.

Question 2

If a patient with joint pain also has systemic symptoms, you know it can’t be _______.

Answer 2

can’t be osteoarthritis - osteoarthritis has no systemic symptoms

Question 3

If a patient has joint pain with inflammation, you know it can’t be _______, but it could be ___________ (3).

Answer 3

can’t be osteoarthritis - osteoarthritis has no/minimal inflammation
could be RA, SLE, gout

Question 4

If a patient has monoarticular joint pain, it could be ______.
If a patient has polyarticular joint pain, it could be ______.

Answer 4

monoarticular: osteoarthritis, gout, septic arthritis
polyarticular: RA, SLE

Question 5

If a patient has joint pain at the DIP, it’s probably _______ and is not ________.

Answer 5

DIP = osteoarthritis

NOT RA

Question 6

If a patient has joint pain at the wrists and metacarpophalangeal joints, it’s probably ________ and not _________.

Answer 6

wrist and knuckles = RA

NOT osteoarthritis

Question 7

If a patient has joint pain at the first metatarsal phalangeal joint, your first thought is ______.

Answer 7

gout

Question 8

Recreational running increases the incidence of osteoarthritis.
T/F

Answer 8

FALSE

competitive contact sports do though

Question 9

bony enlargements at the DIP are called:

Answer 9

Heberden nodes

Question 10

bony enlargements at the PIP are called:

Answer 10

Bouchard nodes

Question 11

You palpate the knee of a patient complaining of knee joint pain. If it feels hard and cool, you think what? If it feels spongy and warm, you think what?

Answer 11

hard and cool = osteoarthritis

spongy and warm = RA

Question 12

First-line therapy for osteoarthritis

Answer 12

acetaminophen

Question 13

What is the conclusive diagnostic test result for confirming gout?

Answer 13

identification of urate crystals in joint fluid or tophaceous aspirate

Question 14

First-line treatment for gout

Answer 14

NSAIDs

Question 15

Your stereotypical gout patient

Answer 15

Male Pacific Islander over age 30

Question 16

A nodular deposit of monosodium urate monohydrate crystals in cartilage, tendon, bone, etc.

Answer 16

tophus

Question 17

Tophi usually develop with the initial attack of gout.

T/F

Answer 17

FALSE

Tophi usually develop years after the initial gout attack.

Question 18

What are the differences between the crystals of gout and pseudogout?

Answer 18

gout crystals: monosodium urate monohydrate, negative birefringence

pseudogout crystals: calcium pyrophosphate, positive birefringence

Question 19

Compare the radiographs of early and late gout.

Answer 19

early gout: no radiographic changes

late gout: punched-out erosions with overhanging rim of cortical bone (“rat bite”) next to a tophus

Question 20

Treatment for asymptomatic hyperuricemia:

Answer 20

NO TREATMENT NECESSARY

Question 21

First-line treatment for acute gout attack:

Answer 21

NSAIDs e.g. naproxen, indomethacin

Question 22

______ is an appropriate treatment for acute gout attack, if the duration of the attack is < 36 hrs

Answer 22

colchicine

Question 23

3 foods/drinks to avoid for patients with gout attacks

Answer 23

beer
organ meats
high fructose corn syrup

Question 24

2 medications to avoid for patients with gout attacks

Answer 24

Thiazide and loop diuretics

Niacin

Question 25

This drug reduces production of uric acid

Answer 25

allopurinol

Question 26

This drug increases excretion of uric acid

Answer 26

probenecid

Question 27

Your patient is having an acute gout attack but also has chronic kidney disease. What medications should you NOT use in this patient?

Answer 27

NSAIDs

colchicine

Question 28

This drug enables humans to metabolize uric acid into allantoin (harmless substance)

Answer 28

pegloticase

Question 29

You have a patient who you are seeing for the first time. He is a 65 year old man who says he has had 3 gout attacks in the past year and wants to know how to prevent them from happening again. His kidney function is fine. What do you do for him?

Answer 29

1. medications to lower uric acid: allopurinol, febuxostat, probenecid, pegloticase
2. avoid purine-containing foods: organ meats, beer, high fructose corn syrup

Question 30

What is the difference in joints usually affected by gout and pseudogout?

Answer 30

gout: first metatarsal phalangeal joint
pseudogout: large joints esp. knees and wrists