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MS1: Gout and SLE Flashcards

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1
Q

what is gout

A

associated w hyperuricemia caused by deposition of monosodium urate crystals or MSU

inflammatory arthritis - group 2

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2
Q

discuss primary gout

A

due to inherited inborn error ng purine metabolism kaya mag kaka hyperuricemia

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3
Q

discuss secondary gout

A

from another disease or from the therapy of it

associated w neoplasm, renal disease, diabetes, hyperlipidemia or metabolic disorders

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4
Q

how does hyperuricemia cause gout

A

excess uric acid in blood forms crystals that collects joint = painful inflammatory response

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5
Q

what are the stages of classic gout

A

asymptomatic hyperuricemia

acute intermittent gout

advanced gout

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6
Q

discuss asymptomatic hyperuricemia

A

pag more than 2 standard dev na

female: > 6 mg/dL
male: > 7 mg/dL

so positive bloodwork but wala pa symptoms

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7
Q

when does acute intermittent gout occur

A

men: 40-60 yo
women: menopause

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8
Q

presentations of acute intermittent gout

A

sudden warmth, swelling, erythema and pain of joint - 4 cardinal signs

monoarticular tas sa 1st MTP - podagra

systemic symptoms - fever, chills and malaise

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9
Q

other possible joints affected by gout

A

midfoot, ankle, heel and knee - LE

less common sa UE - wrist, finger and elbow

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10
Q

discuss acute intermittent stage

A

sa early stages episodes are not as frequent mga years pero evetually it becomes more frequent, longer and more joints

may mga intercritical period

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11
Q

what is intercritical period

A

period where nawala yung symtoms but may MSU crystals padin sa synovial fluid

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12
Q

when is it considered advanced gout

A

pag more than 10 yrs na ng acute intermittent gout

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13
Q

discuss advanced gout

A

aka chronic tophaceous gout - may tophi or parang nodules

associated w:
early onset
untreated gout - 4 attacks per yr

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14
Q

where are subcutaneous tophi commonly found

A

fingers
wrist
ears
knees olecranon
pressure points

also pwede s kidney, heat and sclerae

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15
Q

discuss the pathogensis of gout

A

either may overproduction or underexcretion ng MSU

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16
Q

causes of overproduction of MSU

A

inherited enzyme defect

malignancy, psoriasis and obesity

drugs and food rich in purine

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17
Q

causes of underexcretion of MSU

A

renal problems, dehydration, salt restriction
hypertension
hyperthyroid or hypo
diabetes

ethanol, diuretics, laxative

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18
Q

SSx of gout

A

acute monoarticular arthritis - asymmetric

magising from pain and pressure from clothes in masakit

redness and swelling

low grade fever and chills

pwede mag resolve - masama sa blood

90% sa 1st MTP

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19
Q

how to differentiate heberdens from gout

A

gout is read and whitish tas pag inopen may crystals

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20
Q

other sites of initial gout

A

instep
ankle
heel
knee
wrist

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21
Q

what makes chronic gout a chronic gout

A

may tophi sa bone or skin

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22
Q

discuss tophi

A

higher serum rate = more tophi deposited

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23
Q

typical locations of tophi

A

ear
elbow
finger

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24
Q

discuss diagnosis process for gout

A

has swelling, pain or tenderness in joint or bursa > MSU + = gout

paf naman MSU negative proceed to criteria

if wala swelling pain or tenderness or meron pero sa lumbar or shoulder = not gout

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25
discuss gout classification criteria - patter of joint/bursa involvement
0 - other than ankle, midfoot of 1st MTP 1 - ankle or midfoot 2 - MTP1
26
discuss gout classification criteria - symptomatic episodes
erythema, cant bear touch or difficulty in walking/use joint 0 - none 1 - one 2 - two 3 - three
27
discuss gout classification criteria - time course of episode
0 - no episodes 1 - one 2 - recurrent
28
discuss gout classification criteria - tophus
0 - absent 4 - present
29
discuss gout classification criteria - lab findinfs
basta pag more than 6 mg/dL nag kaka score na nag nnegative score if negative findings
30
discuss gout classification criteria - imaging
4 - evidence of urate deposition 4 - gout related damge
31
discuss imaging for gout
preferred ang CT scan over xray kase di kita sa xray and uric crystals
32
risk factors of gout
hyperuricemia alcohol high meat and seafood intake CANT LEAP drugs obesity hypertension
33
what is CANT LEAP
drug risk factors for gout cyclosporine alcohol nicotine thiazides lasix ethambutol aspirin if low dose pyrazinamide
34
discuss septic arthritis DD from gout
septic: no sex predication group 3 synovial - infectious milky white high grade fever antibiotic treatment knee or shoulder - uncommon ang MTP1
35
discuss other crystal arthropathies DD from gout
need gram stain and cultures
36
medications to lower uric acid level
xanthine oxidase inhibitors - allopurinol, febuxostat and uricase probenecid - inc excretion high dose aspirin
37
medications for gout pain
NSAIDS steroids colchicine
38
what is pseudogout
cause by calcium pyrophosphate dihydrate crystals or CPPD
39
pseudogout is usually associated w ______
trauma, amyloidosis, myxedema, hyperthyroid, gout and hemochromastosis
40
pathophysio of pseudogout
degenerative and often severe but can be asymptomatic intermittent attacks of acute xray shows calcified cartilage
41
where does pseudogout usually occur in the popu
equal gender tas > 60 yo.
42
SSx of pseudogout
acute arthritis in larger joints - knee follows pattern of gout but less severe may chondrocalcinosis sa xray trapezoid shaped crystals
43
identify if gout or pseudogout middle aged men and postmenopausal women
gout
44
identify if gout or pseudogout elderly and equal sex distribution
pseudogout
45
identify if gout or pseudogout mono - small joints and LE
gout
46
identify if gout or pseudogout mono/poly of UE or LE
pseudogout
47
identify if gout or pseudogout acute arthritis is frequent
both
48
identify if gout or pseudogout MSU needle shaped
gout
49
identify if gout or pseudogout CPP rhomboid shaped
pseudogout
50
identify if gout or pseudogout alcohol, trauma, excess meat/fish, medication, stress
gout
51
identify if gout or pseudogout stress and trauma
pseudogout
52
what is calcific tendinitis DD from gout and pseudo gout
hydroxyapatite and crystals tas elderly
53
SLE is more common in what gender
female
54
what is SLE
autoimmune attack on multi systems
55
discuss lab screening for SLE - CBC
look for anemia, leukopenia and throbocytopenia
56
discuss lab screening for SLE - ESR
can be elevated
57
discuss lab screening for SLE - urinalysis
proteinuria, hematuria or + casts
58
discuss lab screening for SLE - ANA and anti-dsDNA/SM
if postive edi may autoimmune/lupus
59
what are the criteria for SLE
DOPAMIN RASH discoid rash oral ulcer photosensitivity arthritis malar rash immunologic disorder neurologic disorder renal disorder antinuclear antibody serositis hematologic 4/11
60
discuss discoid rash
red raised cricular patches tas pwd mag scar sa older
61
discuss oral ulcers
oral or nasopharyngeal tas painless
62
discuss photosensitivity
skin rash due to sunlight
63
discuss arthritis SLE
affects fingers and wrist but non erosive
64
discuss malar rash
butterfly rash over nose
65
discuss neurologic disorder
any - seizures, psychosis mga ganun
66
discuss renal disorders
most dreaded - persistent proteinuria
67
discuss antinuclear antibody
+ = SLE
68
discuss serositis
inflammation lungs - pneumonia heart - pericardial effusion GI - stomach erosion
69
RA vs SLE cause
RA - autoimmune SLE - autoimmune
70
RA vs SLE gender
both female
71
RA vs SLE symptoms
RA - arthritis is erosive and symmetrical, rashes SLE - arthritis is non erosive and non symmetrical, rashes is malar or discoid, ulcer
72
RA vs SLE photosensitivity
meron SLE
73
RA vs SLE severity
RA - less SLE - more
74
non pharmacol treatment of SLE
avoid precipitants, sunblock
75
cutaneous treatment for SLE
avoid sun, sunblock, topical steroids
76
MSK treatment for SLE
NSAIDs, predsinone
77
renal treatment for SLE
Diffuse proliferative glomerulonephritis, high dose steroids, IV cyclophosphamide
78
cardiopulmo treatment for SLE
NSAID and steroids
79
hematologic and neurologic treatment for SLE
mga IV eme eme

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