Exam 3 Gout, Pseudogout, Lupus

Question 1

uric acid is a product of?

Answer 1

purine metabolism

Question 2

Dx and key Sx of excess uric acid

Answer 2

gout.

Question 3

overproduction of uric acid caused by?

Answer 3

malignancy, enzyme defects

Question 4

classic age for gout M and F?

Answer 4

men over 30, women postmenopausal

Question 5

common comorbidity of gout?

Answer 5

renal stones, by a factor of 1000

Question 6

dietary causes of gout?

Answer 6

alcohol, high purine foods like organ meats, spinach, asparagus, beans etc

Question 7

stage 1 of gout and how to diagnose?

Answer 7

asymptomatic hyperuricemia, diagnose with uric acid levels. rarely diagnosed at this stage

Question 8

stage2 of gout and how to diagnose?

Answer 8

acute gouty arthritis, pain. usually post alcohol, uric rich food binge.

Question 9

stage 3 of gout and how to diagnose?

Answer 9

intercritical gout, intermittent attacks, normal triggers.

Question 10

stage 4 of gout and how to diagnose?

Answer 10

chronic tophaceous gout. presence of tophi

Question 11

gold standard gout Dx test?

Answer 11

arthrocentisis with culture and gram stain, look for urate crystals NEGATIVELY BIREFRIGENT

Question 12

the less optimal test for gout Dx?

Answer 12

serum uric acid. elvated does not always predict gout.

Question 13

complications of gout seen on Xray?

Answer 13

joint erosion, “rat bite” appearance

Question 14

which joint does gout prefer?

Answer 14

usually first joint, usually big toe.

Question 15

how many stages of gout Tx and what are they?

Answer 15

3 stages. acute, prophylaxis, lower uric acid stores

Question 16

first line Tx for acute attack of gout?

Answer 16

NSAIDS. indomethacin (often appears on board)

Question 17

contraindications of indomethacin?

Answer 17

gi bleed, renal impairment, PUD

Question 18

what must be ruled out before steroid Tx of gout?

Answer 18

bacterial infection. steroids will exacerbate.

Question 19

2nd line Tx of acute gout?

Answer 19

Colchicine, rarely used. lots of side effects

Question 20

best drug for gout prevention?

Answer 20

Colchicine, same as the drug rarely used 2nd line for acute Tx

Question 21

best drug for long term management of gout overproducers?

Answer 21

allopurinol, prevention only.

Question 22

best drug for long term management of gout underproducers?

Answer 22

probenecid

Question 23

patients of great concern when treating gout?

Answer 23

those with renal issues

Question 24

pseudogout causative agent?

Answer 24

CPPD calcium crystals

Question 25

most common age group pseudogout?

Answer 25

elderly

Question 26

joints affected by psuedogout?

Answer 26

50% in knees, then anywhere else including larger joints

Question 27

DDx of pseudogout and osteoarthritis and RA?

Answer 27

pseudogout has redness in addition to pain. OA only pain no redness. RA order rheumatoid factor test

Question 28

finding of pseudogout fluid aspiration?

Answer 28

positively birefringent. true gout is negative birefrigent.

Question 29

Tx for pseudogout?

Answer 29

aspiration, NSAIDs

Question 30

prophylaxis for pseudogout?

Answer 30

colchicine. use caution. many side effects

Question 31

cause of SLE?

Answer 31

autoimmune. research ongoing

Question 32

demographic of SLE?

Answer 32

females 7 times more likely, black women 4 times more

Question 33

etiology of SLE?

Answer 33

antigen/antibody complexes deposited in tissue

Question 34

key Sx of SLE?

Answer 34

MALAR butterfly rash (only systemic, not discoid), photosensitivity, sometimes alopecia

Question 35

board test concern for SLE?

Answer 35

raynaud's phenomenon often described on boards along with malar rash

Question 36

initial lab tests for SLE?

Answer 36

antinuclear antibody and erythrocyte sedimentation rate

Question 37

SLE Tx?

Answer 37

NSAIDs first line. depends on severity of illness

Question 38

possible complications of SLE?

Answer 38

lupus nephritis, CNS involvement, thrombocytopenia, antiphospholipid antibodies

Question 39

how to Dx drug induced SLE?

Answer 39

anti-hitone antibody test if pt. taking a drug for more than a month presenting with SLE Sxs

Question 40

major drug associated with drug induced SLE?

Answer 40

procainamide

Question 41

course of SLE?

Answer 41

chronic, relapsing and remitting.

Question 42

sjorgen syndrome associations?

Answer 42

SLE, RA

Question 43

presentation of SS?

Answer 43

chronic lacrimal and salivary gland dysfxn. dry eye, dry mouth. low production of tears and saliva (sicca Sx)

Question 44

Tx of SS?

Answer 44

saliva replacement, artificial tears, NSAIDs

Question 45

mechanism of scleroderma/systemic sclerosis?

Answer 45

tighten and thicken tissues. narrowing small vasculature. scleroderma on the skin. systemic sclerosis, organs/connective tissue etc.

Question 46

board concern for scleroderma/systemic sclerosis?

Answer 46

CREST syndrome, limited classification

Question 47

lab tests for scleroderma/systemic sclerosis?

Answer 47

ANA positive, anti centromere antibodies (ACA)

Question 48

Tx for scleroderma/systemic sclerosis?

Answer 48

Sx and supportive. Tx Raynaud's with calcium channel blockers