Gout and pseudogout

Question 1

Gout: what is it?

Answer 1

acute inflammatory monoarthritis caused by precipitation of monosodium urate crystals

Question 2

Does gout cause mono- or multi-arthritis?

Answer 2

mono

Question 3

what causes gout?

Answer 3

monosodium urate crystals

Question 4

acute inflammatory monoarthritis caused by precipitation of monosodium urate crystals. what is this?

Answer 4

gout

Question 5

what are risk factors for gout?

Answer 5

hyperuricemia (strongest)

male
hypertension
obesity
diabetes
dyslipidemia
alcohol use

Question 6

hyperuricemia is a risk factor for what?

Answer 6

gout

Question 7

what can cause hyperuricemia?

Answer 7

• underexcretion (90% of patients): idiopathic
  (sometimes potentiated by renal failure)

overproduction (10% of patients)

Question 8

what can exarcerbate underexcretion of uric acid?

Answer 8

alcohol and medications such as diuretics

Question 9

what conditions can cause overproduction of uric acids?

Answer 9

Lesch-Nyhan syndrome (genetic kidney failure disorder)
PRPP excess
increased cell turnover (tumor lysis syndrome)
van Gierke disease (can’t break down glycogen)

Question 10

hyperuricemia
male
hypertension
obesity
diabetes
dyslipidemia
alcohol use

risk factors for what?

Answer 10

gout

Question 11

what do gout crystals look like under microscope?

Answer 11

needle shaped and +birefringent (yellow on parallel light, blue under perpendicular light)

Question 12

what is the shape of gout crystals?

Answer 12

needle

Question 13

what is +birefringent?

Answer 13

yellow under parallel light
blue under perpendicular light

Question 14

needle shaped +birefringent crystals under microscope. what is it?

Answer 14

gout crystals (uric acid)

Question 15

can serum uric acid levels during gout attack be normal?

Answer 15

yes

Question 16

are serum uric acid levels during gout attack always elevated?

Answer 16

no

Question 17

Gout: symptoms?

Answer 17

joint swollen, red, painful (asymmetric). classically of big toe

tophus formation on ears, elbow, achilles tendon

after certain events (meals, alcohol, surgery, trauma, diuresis, dehydration)

Question 18

after which events does a gout attack usually occur?

Answer 18

after big meal rich in purines (red meat, seafood)
alcohol consumption
trauma
surgery
dehydration
diuresis

Question 19

which foods are rich in purines?

Answer 19

red meat, seafood

Question 20

what is the classic manifestion of gout?

Answer 20

red, painful, swollen MTP joint of big toe (podagra)

Question 21

what is podagra?

Answer 21

red, painful, swollen MTP joint of big toe

Question 22

where is the MTP joint?

Answer 22

foot

Question 23

where is the MCP joint?

Answer 23

hand

Question 24

another name for red, swollen, painful MTP joint of big toe?

Answer 24

podagra

Question 25

where do gout tophi usually occer?

Answer 25

ear, olecranon (elbow) and achilles heel

Question 26

red, painful, swollen MTP joint of big toe. suggestive of?

Answer 26

gout

Question 27

why can alcohol (beer more than spirits) consumption trigger gout?

Answer 27

metabolitis compete for the same excretion sites in kidney as uric acid uric acid therefore builds op in blood

Question 28

gout: treatment?

Answer 28

colchicine NSAIDs glucocorticosteroids

Question 29

what does colchicine do?

Answer 29

inhibits innate immune system. stops inflammatory reaction gout treatment

Question 30

what is the preventive treatment of gout?

Answer 30

allopurinol (inhibits enzyme that produces uric acid) febuxostat

Question 31

what does allopurinol do?

Answer 31

inhibits enzyme that produces uric acid

Question 32

what is another name for pseudogout?

Answer 32

calcium pyrophosphate deposition disease

Question 33

what is another name for calcium pyrophosphate deposition disease?

Answer 33

pseudogout

Question 34

what happens in pseudogout?

Answer 34

deposition of calcium pyrophosphate crystals in the joint spaces

Question 35

what happens in pseudogout calcium pyrophosphate deposition disease?

Answer 35

deposition of calcium pyrophosphate crystals in the joint spacesw

Question 36

what is the old name for calcium pyrophosphate deposition disease?

Answer 36

pseudogout

Question 37

calcium pyrophosphate deposition disease: how old are the patients, which sex M/F?

Answer 37

>50 y/o both sexes affected affected equally

Question 38

calcium pyrophosphate deposition disease: most common cause is idiopathic?

Answer 38

yes

Question 39

calcium pyrophosphate deposition disease: what is it associated with?

Answer 39

hemochromatosis hyperparathyriodism joitn trauma

Question 40

hemochromatosis hyperparathyriodism joint trauma associated with what?

Answer 40

calcium pyrophosphate deposition disease

Question 41

deposition of calcium pyrophosphate crystals in the joint spaces what is this?

Answer 41

calcium pyrophosphate deposition disease or pseudogout

Question 42

calcium pyrophosphate deposition disease: acute symptoms?

Answer 42

pain and swelling with acute inflammation of joint most commonly knee

Question 43

what is the most commonly affected joint in calcium pyrophosphate deposition disease?

Answer 43

knee

Question 44

calcium pyrophosphate deposition disease: chronic symptoms?

Answer 44

degeneration of joint

Question 45

how do you call chronic pseudogout?

Answer 45

pseudo-osteoarthritis

Question 46

what is pseudo-osteoarthritis?

Answer 46

chronic pseudogout (calcium pyrophosphate depostion disease) which causes degeneration of joint

Question 47

calcium pyrophosphate deposition disease: x-ray finding?

Answer 47

chondrocalcinosis (calcium in cartilage within joint space)

Question 48

chondrocalcinosis in joint on x-ray. suggestive of what?

Answer 48

calcium pyrophosphate deposition disease

Question 49

calcium pyrophosphate deposition disease: what do crystals under microscope look like?

Answer 49

rhomboid (ruit) weakly +birefringent (blue when parallel to light)

Question 50

Crystals under microscope: rhomboid (ruit) weakly +birefringent (blue when parallel to light) which disease?

Answer 50

calcium pyrophosphate deposition disease

Question 51

Acute treatment calcium pyrophosphat deposition disease?

Answer 51

colchicine NSAIDs glucocorticosteroids (same as gout)

Question 52

what is weakly +birefringent?

Answer 52

blue when under parallel light (pseudogout)

Question 53

what is prophylaxis for calcium pyrophosphate deposition disease?

Answer 53

colchicine

Question 54

what are the 'blue P's' of calcium pyrophosphate deposition disease?

Answer 54

blue Parallel (weakly +birefringent) Positive birefringent calcium Pyrophosphate Pseudogout