Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
34 Cards in this Set
- Front
- Back
|
Define gout
|
manifestation of an inflammatory response to crystal deposition in synovial joints.
|
|
|
Does gout affect more men or more women?
|
More men than women, although gout is common in women over 50 taking diuretics.
|
|
|
How does gout present at onset?
|
as hyperacute monoarthritis
severe swelling erythema & pain |
|
|
In what joints does gout occur in the foot?
|
most in the 1st MTPJ
|
|
|
Name the three phases of gout, which occur if not treated
|
Phase1 chronic asymptomatic gout
Phase 2 acute intermittent gout Phase 3 chronic tophaceous gout |
|
|
What duration does chronic asymptomatic gout continue for?
|
can last decades
|
|
|
How long does Acut Intermittent gout usually last?
|
can last years
|
|
|
What lifestyle adjustments constitute the management of chronic asymptomatic gout?
|
1. reduce weight
2. reduce purine intake 3. stop drinking alcohol |
|
|
What foodstuffs contain high levels of purines?
|
oats
spinach red meat seafood |
|
|
How does acute gout progress if no treatment is given?
|
progresses to chronic tophaceous gout
|
|
|
Name the 5 features of an ACUTE gout attack.
|
1. red, hot, shiny, swollen joint
2. very painful 3. rapid onset (overnight) 4. single joint affected 5. subsides in days |
|
|
Where do tophi form?
|
In the joint at the margin of capsule and bone
|
|
|
Name some sites where tophi can form
|
digits, earlobes, synovial sheaths
|
|
|
What do tophaceous joints feel like on palpation?
|
swollen around joint, hard and "crunchy"
|
|
|
Ddx for gout?
|
septic arthritis
|
|
|
Why do tophi form at the extremities?
|
Sodium urate crystals precipitate in lower temperatures
|
|
|
What three testing modalities can confirm a diagnosis of gout?
|
1. Aspiration of synovial fluid
2. Blood tests 3. X-ray |
|
|
How might you differentiate between gout and septic arthritis?
|
use gram-staining
Gout-->no sepsis Septic arthritis-->sepsis |
|
|
What would you expect the appearance of synovial fluid to be if there was gout present?
|
1. "urate milk" would be visible
2. crystals visible by polarised light |
|
|
What blood tests would you order for gout?
|
CRP
ESR Serum Urate |
|
|
What is a normal level of serum urate in blood?
|
<300 micromols/L
|
|
|
What would happen to CRP and ESR levels during an acute gout attack?
|
CRP and ESR would be raised
|
|
|
When do radiological changes become evident in gout?
|
only after many acute attacks
|
|
|
Both septic arthritis and gout may present with a hot, red, swollen monoarthritis. How would you distinguish between condition?
|
Septic joint aspirate (not gout)
Fever (not gout) Larger joints involved (not gout) |
|
|
Management goals in 1st phase gout?
|
Low purine diet
Reduce blood pressure/weight No alcohol Increase Vitamin C |
|
|
Treatment goals for intermittent acute gout?
|
Pain relief
Prevent tophus formation |
|
|
Drug therapy for acute intermittent gout?
|
High dose NSAIDs (diclofenac)
Antihyperuricemic drugs (allopurinol) Colchicine |
|
|
Non-drug therapy for acute intermittent gout?
|
ice packs
|
|
|
Management of tophaceous gout?
|
Antihyperuricemic drugs (allopurinol)
|
|
|
How does gout affect cardiovascular risk status?
|
Gout increases cardiovascular risk.
|
|
|
How can you differentiate between gout and other inflammatory arthropathies using ice?
|
gout --> likes ice applied
others -->prefer warmth on joint |
|
|
What is pseudogout?
|
calcium pyrophosphate crystals relese from joint cartilage
|
|
|
What is the commonest monoarthritis in the elderly?
|
pseudogout
|
|
|
What 4 local tissue factors can cause precipitation of urate crystals?
|
1. hyperuricemia
2. low pH 3. low temperature 4. local pressure |
