Crystal Associated Arthropathies (Msq Drill 153)

1. Which stage of gout is characterized by tophaceous nodules?

Asympatomatic

Acute

Chronic

2. Because allopurinol can make gout worse, it should only be taken when the acute episode is over, rather acute treatment should be initiated with "other" drugs. True or false?

True

False

3. Is there a strong familial link to gout?

Yes

No

4. In other words patients who have had a transplant and are taking cyclosporine will have rapid development of tophi. true or false?

True

False

5. If you have multiple intermittent attacks of acute gout, you can eventually develop tophi anywhere over the body. True or false?

True

False

6. So, urate crystals will be present in synovial fluid?

Yes

No

7. Does the gouty arthritis usually subside on it own?

Yes in about 3-10 days

No, it will need to be treated in order for it to subside in 3-10 days

8. Is gout usually monoarticular or polyarticular?

Monoarticular

Polyarticular

9. So psuedogout is:

Monosodium urate monohydrate

Calcium pyrophosphate dihydrate

Calcium oxalate

Calcium phosphate

other causes for calcium pyrophosphate dihydrate crystals are asymptomatic chondroclacinosis and chronic arthropathy.

Explanation

other causes for calcium pyrophosphate dihydrate crystals are asymptomatic chondroclacinosis and chronic arthropathy.

10. The vast majority of patients with hyperuricemia do hot have symptoms. True or false?

True

False

You do not have to treat asymptomatic pts with hyperuricemia.

Explanation

You do not have to treat asymptomatic pts with hyperuricemia.

11. In females the same adult levels are reached at:

Puberty

Later adolescents

Menopause

12. After monopause, does the incidence of gout in women increase?

Yes

No

13. So, basically you should use allopurino, probenecid and uloric to treat chornic gout after stabilization by acute meds. True or false?

True

False

14. Which of the following are other drugs and toxins that can lead to UNDEREXCRETION of uric acid therefore hyperuricemia?

Diuretics esp HCTZ

Ethanol

Cyclosporine A

Pyrazinaide

Lead neprhopathy

Submit

15. Under polarized microscopy gout crystals will look:

Needle shaped

Round shaped

Rhomboid shaped

16. Gout is basically hyperuricemia. How can hyperuricemia come about?

Increased production only

Decreased excretion only

Both increased production and decreased secretion

17. Psuedogout is caused by calcium pyrophosphate dihydrate crystals. True or false?

True

False

18. Uric acid levels confirm a diagnosis of gout. True or false?

True

False

A patient may have asymptomatic hyperuricemia that does not need to be treated.

Explanation

A patient may have asymptomatic hyperuricemia that does not need to be treated.

19. Initial attack of gout in 75% of patients is in the:

1st MCP

2nd MTP

3rd MCP

1st MTP

20. Gout is mostly a disease of:

Adolescent males

Adult males

Adolescent girls

Adult women

21. Alloupurinol is used in the treatment of gout. Can allopurinol actually makes gout worse?

Yes

No

22. Does the joint fluid show an inflammatory process in patients with gout?

Yes, there is also an increasein PMN's

No, gout is not an inflammatory process

poly morpho nuclear cells are granulocytes.

Explanation

poly morpho nuclear cells are granulocytes.

23. 95% of the time does gout attack one joint or many joints?

One joint

Many joints

24. Can you have gouty arthritis and yet have NO hyperuricemia?

Yes

No

You never check for uric acid level to see if a patient has gout. The uric acid has moved out of the serum into the joint.

Explanation

You never check for uric acid level to see if a patient has gout. The uric acid has moved out of the serum into the joint.

25. If you treat chronic gout appropriately can the tophi go away?

Yes

No

26. Gicing a patient aspirin can lead to?

Overproduction of uric acid

Under excretion of uric acid

27. Other NSAIDS work just as well as indomethacin in alleviating the symptoms of gout. True or false?

True

False

28. In the asymptomatic stage of gout, does the patient have hyperuricemia?

Yes

No

29. Which epideiological group NEVER suffers from gout?

Postmenopausal women

Premenopausal women

Adult men

Estrogen appears to be protective of developing gout.

Explanation

Estrogen appears to be protective of developing gout.

30. The following crystals can be found in synovial fluid. Which type is associated with acute and tophaceous gout and can be seen in asymptomatic hyperuricemia or intercritical gout?

Monosodium urate monohydrate crystals

Calcium pyrophsophate dihydrate crystals

Calcium oxalate

31. What type of drug is probenecid?

A xanthine oxidase inhibitor

A uricosuric

32. Indomethacin is an NSAID that has been used extensively in the treatment of gout. Its use is limited now due to its propensity to be:

Hepatotoxic

Nephrotoxic

Ototoxic

33. What will the crystals look like if you do an arthrocentesis in a patient with psuedogout?

Needle like

Round

Rhomboid like

34. Which of the following are used in the acute treatment of gout?

NSAIDS

Colchicine

Prednisone

Intrarticular steroid injection

Allopurinol

allopurinol is used to treat chronic gout.

Explanation

allopurinol is used to treat chronic gout.

Submit

35. Diagnosis of of gout is confirmed by:

Serum crystal level

Arthrocentesis

Clinical observation

36. ETOH leads to which process that leads to hyperuricemia?

Underexcretion only

Overproduction only

Both overproductoin and underexcretion

37. The peak incidence of gout is in which decade of life?

3d

4th

5th

6th

7th

38. What joint in the body is NEVER affected by acute gouty arthritis?

Elbow

Shoulder

Knee

Ankle

1st MtP

39. In males adult levels of urate are reached at what age?

At puberty

At late adolescents

In the early 20s

40. Which stage of gout is characterized by intermittent attacks?

Assymptomatic

Acute

Chronic

41. Patients with gouty arthritis will often complain of AN ABRUPT ONSET of pain that began:

When they were at work

Late in the afternoon

Early in the morning

At night

42. What is the upper limit for normal serum uric acid levels?

6-6.5mg/dl

7-7.5. mg/dl

8-8.5mg/dl

9-9.5mg/dl

43. What joint is usually initially affected by pseudogout?

The ankle

The 1st MTP

The knee

The hip

44. Which of the following lead to hyperuricemia as a result of overproduction?

HGPRT or G6PD deficiency

PrPP synthetase overactivity

Myoproliferative disorders

Low dose aspririn

Sicle cell anemia

low dose aspirin leads to undersecretion of uric acid.

Explanation

low dose aspirin leads to undersecretion of uric acid.

Submit

45. Which of the following are used to treat chronic gout?

Colchicine

Allopurinol

Probenecid

Uloric

Submit

46. Basically uric acid is the end product of degradation of purine compunds. If you lack the following enzymes that are responsible for the oxidation of uric acid you can develop hyperuricemia?

Xanthine oxidase

Uric acid oxidase

Uricase

xanthine oxidase is involved inthe formation of uric acid and not the break down.

Explanation

xanthine oxidase is involved inthe formation of uric acid and not the break down.

Submit

47. What is the leukocyte count between in patients with Gout?

50 000 - 80 000

5000 -80 000

15 000 - 20 000

48. The following are provocative facotrs of acute attacks of gout. Which factor is the reason why the first MTP is usually the first joint attacked by gout?

Trauma

Alcohol ingestion

Drugs such as thiazide diuretics, low dose aspirin and allopurinol

49. These patients who have had a transplant and are taking cyclosporine will still have an episode of asymptomatic hyperuricemia, the only difference is that this episode will be shorter than average or will last longer than average?

Lasts longer

Lasts for a shorter time

50. DanPatients who have a had a transplant and are taking _____ have a very high risk of developing gout.

Methotrexate

Sulfasalizine

Cyclosporine

Azathiprine

51. The following are all causes of early onset gout. Which one is the only one that is associated with premonopausal women developing gout?

Enzymatic defects inthe purine pathways

Glycogens torage disease

Hemoglobinaopathies

Familial urate nephropathy

52. Which of the following conditions are associated with psuedogout?

Hyperthyroidism

Hypothyroidism

Hemochromatosis

Hyperparathyroidism

Submit

53. Processes that lead to increased breakdown of cellular components results in increased production ofuric acid. Which of the following can lead to hyperuricemia die to increased production?

Leukemia

Diuretics

Hemolytic anemia

Idiopathic

diuretics lead to hyperuricemia due to undersecretion as they compete with uric acid crystals at the distal tubules.

Explanation

diuretics lead to hyperuricemia due to undersecretion as they compete with uric acid crystals at the distal tubules.

Submit

Crystal Associated Arthropathies (Msq Drill 153)

1. Which stage of gout is characterized by tophaceous nodules?

2.

What first name or nickname would you like us to use?

2. Because allopurinol can make gout worse, it should only be taken when the acute episode is over, rather acute treatment should be initiated with "other" drugs. True or false?

3. Is there a strong familial link to gout?

4. In other words patients who have had a transplant and are taking cyclosporine will have rapid development of tophi. true or false?

5. If you have multiple intermittent attacks of acute gout, you can eventually develop tophi anywhere over the body. True or false?

6. So, urate crystals will be present in synovial fluid?

7. Does the gouty arthritis usually subside on it own?

8. Is gout usually monoarticular or polyarticular?

9. So psuedogout is:

10. The vast majority of patients with hyperuricemia do hot have symptoms. True or false?

11. In females the same adult levels are reached at:

12. After monopause, does the incidence of gout in women increase?

13. So, basically you should use allopurino, probenecid and uloric to treat chornic gout after stabilization by acute meds. True or false?

14. Which of the following are other drugs and toxins that can lead to UNDEREXCRETION of uric acid therefore hyperuricemia?

15. Under polarized microscopy gout crystals will look:

16. Gout is basically hyperuricemia. How can hyperuricemia come about?

17. Psuedogout is caused by calcium pyrophosphate dihydrate crystals. True or false?

18. Uric acid levels confirm a diagnosis of gout. True or false?

19. Initial attack of gout in 75% of patients is in the:

20. Gout is mostly a disease of:

21. Alloupurinol is used in the treatment of gout. Can allopurinol actually makes gout worse?

22. Does the joint fluid show an inflammatory process in patients with gout?

23. 95% of the time does gout attack one joint or many joints?

24. Can you have gouty arthritis and yet have NO hyperuricemia?

25. If you treat chronic gout appropriately can the tophi go away?

26. Gicing a patient aspirin can lead to?

27. Other NSAIDS work just as well as indomethacin in alleviating the symptoms of gout. True or false?

28. In the asymptomatic stage of gout, does the patient have hyperuricemia?

29. Which epideiological group NEVER suffers from gout?

30. The following crystals can be found in synovial fluid. Which type is associated with acute and tophaceous gout and can be seen in asymptomatic hyperuricemia or intercritical gout?

31. What type of drug is probenecid?

32. Indomethacin is an NSAID that has been used extensively in the treatment of gout. Its use is limited now due to its propensity to be:

33. What will the crystals look like if you do an arthrocentesis in a patient with psuedogout?

34. Which of the following are used in the acute treatment of gout?

35. Diagnosis of of gout is confirmed by:

36. ETOH leads to which process that leads to hyperuricemia?

37. The peak incidence of gout is in which decade of life?

38. What joint in the body is NEVER affected by acute gouty arthritis?

39. In males adult levels of urate are reached at what age?

40. Which stage of gout is characterized by intermittent attacks?

41. Patients with gouty arthritis will often complain of AN ABRUPT ONSET of pain that began:

42. What is the upper limit for normal serum uric acid levels?

43. What joint is usually initially affected by pseudogout?

44. Which of the following lead to hyperuricemia as a result of overproduction?

45. Which of the following are used to treat chronic gout?

46. Basically uric acid is the end product of degradation of purine compunds. If you lack the following enzymes that are responsible for the oxidation of uric acid you can develop hyperuricemia?

47. What is the leukocyte count between in patients with Gout?

48. The following are provocative facotrs of acute attacks of gout. Which factor is the reason why the first MTP is usually the first joint attacked by gout?

49. These patients who have had a transplant and are taking cyclosporine will still have an episode of asymptomatic hyperuricemia, the only difference is that this episode will be shorter than average or will last longer than average?

50. DanPatients who have a had a transplant and are taking _____ have a very high risk of developing gout.

51. The following are all causes of early onset gout. Which one is the only one that is associated with premonopausal women developing gout?

52. Which of the following conditions are associated with psuedogout?

53. Processes that lead to increased breakdown of cellular components results in increased production ofuric acid. Which of the following can lead to hyperuricemia die to increased production?