449 exam 2

Uric acid goal in goat

<6

NSAIDs and dose for acute gout

-indomethacin 25 - 50mg q8hr -naprosyn 750mg X1 then 250mg q 8 hour

acute gout prevention

-low purine diet -avoid aggravating factors -colchicine .6mg 1-2X/day

Gout presentation

-monoauricular -Acute onset -Attacks at night or am -Typically involves 1st MTP -Heat, redness and swelling of joint -Hyperalgesia

34. Treatment of pseudogout can include all of the following except: A. NSAIDs. B. colchicine. C. allopurinol. D. oral corticosteroids.

C

Which of the following dietary supplements is associated with increased risk for gout? A. vitamin A B. gingko biloba C. brewer's yeast D. glucosamine

C

Which of the following foods is least likely to trigger acute gouty arthritis? A. mussels B. beef liver C. hard cheese D. spinach

C

Differentiation between gout and pseudogout can involve all of the following diagnostic approaches except: A. analysis of minerals in the blood. B. analysis of joint fluid. C. x-ray of the affected joint. D. measuring thyroid function.

C. X-ray of the affected joint

The most helpful diagnostic test to perform during acute gouty arthritis is: A. measurement of erythrocyte sedimentation rate (ESR). B. measurement of serum uric acid. C. analysis of aspirate from the affected joint. D. joint radiography.

C. analysis of aspirate from the affected joint.

Secondary gout can be caused by all of the following conditions except: A. psoriasis. B. hemolytic anemia. C. bacterial cellulitis. D. renal failure.

C. bacterial cellulitis.

Risk factors for acute gouty arthritis include: A. obesity. B. female gender. C. rheumatoid arthritis. D. joint trauma.

A

labs for gout

cbc, uric acid (>7.5 = hyperureciemia), ESR

corticosteroid administration for acute gout attack

for refractory cases or when NSAIDs contraindicated

Which of the following patients with acute gouty arthritis is the best candidate for local corticosteroid injection? A. a 66-year-old patient with a gastric ulcer B. a 44-year-old patient taking a thiazide diuretic C. a 68-year-old patient with type 2 diabetes mellitus D. a 32-year-old patient who is a binge drinker

A

Pegloticase (Krystexxa®) reduces serum uric acid levels by: A. reducing the production of urea. B. converting uric acid to allantoin. C. blocking conversion of urea to uric acid. D. binding to uric acid and facilitating elimination through the gastrointestinal (GI) system.

B

First-line therapy for treating patients with acute gouty arthritis usually includes: A. aspirin. B. naproxen sodium. C. allopurinol. D. probenecid.

B. Naproxen sodium

The use of all of the following medications can trigger gout except: A. aspirin. B. statins. C. diuretics. D. niacin.

B. Statins

The clinical presentation of acute gouty arthritis affecting the base of the great toe includes: A. slow onset of discomfort over many days. B. greatest swelling and pain along the median aspect of the joint. C. improvement of symptoms with joint rest. D. fever.

B. greatest swelling and pain along the median aspect of the joint.

The most common locations for tophi include all of the following except: A. the auricles. B. the elbows. C. the extensor surfaces

D

Tophi are best described as: A. ulcerations originating on swollen joints. B. swollen lymph nodes. C. abscesses with one or more openings draining pus onto the skin. D. nontender, firm nodules located in soft tissue.

D. Nontender, firm nodules located in soft tissue

Pseudogout is caused by the formation of what type of crystals in joints? A. uric acid B. calcium oxalate C. struvite D. calcium pyrophosphate dihydrate

D. calcium pyrophosphate dihydrate

Treatment for acute gout attack

NSAIDs, glucocorticoids, colchicine

Indicate whether each medication is used for prevention (P) or treatment (T) of gout. 26. febuxostat (Uloric®) 27. colchicine 28. allopurinol (Aloprim®)

P T P

When should long term meds start

after acute has resolved

What med prevents MSU crystals in gout

allopurinol 300mg daily increase to 800 as tolerate

Pseudogout has been linked with abnormal activity of the: A. liver. B. kidneys. C. parathyroid. D. adrenal gland.

c. parathyroid

what is found in gout joint aspiration

monosodium urate crystals

How is colchicine administered in an acute gout attack?

must take w/in 48hours of attack. 1.2 mg onset. repeat .6mg 1 hour later