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1

What is Raynaud's phenomenon?

peripheral digital ischemia due to paroxysmal vasospasm affecting arteries supplying fingers and toes

2

What precipitates Raynaud's syndrome?

cold

3

What relieves Raynaud's syndrome?

heat

4

What are the symptoms of Raynaud's syndrome?

numbness, burning sensation, severe pain when warmed up

5

Who is mainly affected by Raynaud's syndrome?

young women

6

What happens in Raynaud's syndrome?

initial pallor from vasoconstriction, followed by cyanosis due to sluggish blood flow, then redness from hyperamia

7

DD of Raynaud's syndrome?

autoimmune rheumatic disease, bb therapy, raynauds disease

8

What is the treatment of Raynaud's syndrome?

stop smoking, keep hands and feet warm, oral nefdipine, prostacyclin infusions, lumbar symphathectomy, evening primrose oil, sildenafil, prostsacyclin, vasodilators, avoid vibrating tools

9

What are the causes of gout?

hereditary, increased dietary purines, alcohol excess, diuretics, leukaemia, cytotoxics

10

Where do we acquire purines from?

from the break down of food or break down inown tissues in pathway

11

What are purines broken down into?

hypoxanthine, xanthine and then uric acid to be carried around in the bloodstream

12

What are the two outcomes for uric acid in humans?

be removed by the kidney or into monosodium urate crystals

13

What happens if there us a build up on uric acid?

overflows in the kidneys and becomes crystals in the joints and tissues

14

What can cause a increase of urate?

increased urate in diet, increase in cell death and turnover, increased cell damage, decreased excetion, drugs, fructose, genetics, increase in insulin levels, red meat, seafood

15

What 4 conditions can hyperuricaemia and deposition of sodium urate crystals result in?

acute gout, chronic polyarticular gout, chronic tophaceous gout, urate renal stone formation

16

What conditions can gout be a marker for?

CV disease, hypertension, diabetes, chronic renal failure

17

How common is gout?

prevalence is around 1%

18

Is gout more common in males or females?

Male, rare before adulthood

19

How many people with hyperuricaemia develop gout?

20%

20

What foods help against gout?

dairy, cherries, vit C, carbohydrate, smaller meals, 2000 calories

21

What is the saturation point of uric acid compared to the normal range?

Normal = 200-430umol/L
Saturation = 380umol/L

22

What is acute gout?

inflammatory arthritis caused by hyperuricaemia and intra articular sodium urate crystals

23

What causes acute gout?

A sudden change in blood:tissue urate balance, either sudden overload or sudden reduction (ULT), cold, trauma, sepsis, dehydration, drugs

24

What symptoms does acute gout cause?

urate crystals trigger intracellular inflammation, causes severe pain, swelling, redness, commonly on metatarsophalangeal joint of big toe

25

What is the treatment of acute gout?

colchicine 500ug max tds, NSAIDs, steroids, ice, cherries, vit C, coxib

26

How does chronic trophaceous gout present?

large, smooth, white deposits (tophi) in the skin and around the joints, particularly on ear, fingers and Achilles tendon

27

What investigations can be used for gout?

polarised light microscopy of joint synovial fluid shows negatively birefringent urate crystal, raised serum urate (but can be normal in acute attack), radiographs show tissue swelling, serum urea and creatinine show renal impairment, well defined punched out erosions in juxta articular bone, no sclerotic reaction, joint spaces preserved till late

28

What is the long term treatment of gout?

stop diuretics and use losartan or fenofibrate instead, reduce weight, stop smoking, change diet, reduce alcohol, allopurinol 100mg/day, colchicine, NSAIDs, steroids

29

What should the starting dose for allopurinol be and how much should it be increased by if serum urate is not below 300 - WITH NO RENAL IMPAIRMENT??

100mg/day, increased by 100mg

30

What should the starting dose for allopurinol be and how much should it be increased by if serum urate is not below 300 - WITH RENAL IMPAIRMENT??

1.5mg/unit eGFR/day and increase by 1.5mg/unit eGFR/day