6278204
Descripción
Fichas por Andrew Street, actualizado hace más de 1 año
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Creado por Andrew Street
hace alrededor de 8 años
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| Pregunta | Respuesta |
| Crystal related arthropathy defines a syndrome of s..... in response to crystal d...../f..... in the joint. Two types of crystal are commonly implicated: monosodium urate (g.....) & calcium pyrophosphate dihydrate (p.....). G..... is more common. | Crystal related arthropathy defines a syndrome of synovitis in response to crystal depostition/formation in the joint. Two types of crystal are commonly implicated: monosodium urate (gout) & calcium pyrophosphate dihydrate (pseudogout). Gout is more common. MAAG p451. |
| 1792 Describe the classical presentation, precipitating factors, & clinical features of gout. | Acute gout typically presents in a middle aged male with sudden onset of +++P, swelling, & redness in 1st MTP. Too much food, alcohol, dehydration, exercise, or starting a diuretic may precipitate an attack. Chronic clinical features: * gouty tophi on pinnae * Olecranon bursitis * Gouty tophi on hands * Gouty nephropathy * Large joint oligoarthritis 50% of first attacks start in MTP but 10% are polyarticular. MAAG p451. |
| 1793 List causes of hyperuricaemia. | * Inherited enzyme deficiencies * Excess precursor production - myeloproliferative DS, severe psoriasis, cytotoxic chemotherapy, rich diet, alcohol * Decreased excretion - renal impairment (may be secondary to medication - eg low dose aspirin, furosemide, thiazides). MAAG p450. |
| 1794 Ix of gout. | * Clinical picture is often diagnostic as is rapid response to NSAIDs or colchicine. * Joint fluid microscopy - difficult to perform * Serum uric acid - usually ^ (>600 umol/L) * Serum urea, creatine, eGFR - for signs of renal impairment. K & C p531. |
| 1795 Demonstrate how to counsel a patient regarding diet to reduce the risk of gout Sx. | Reduce foods high in purines - these include: * Alcohol - esp beer * Non-diet carbonated drinks * Offal * Certain fish & shellfish * Spinach * Encourage a diet which reduces calorific & cholesterol intake. K & C p531. |
| 1798 Discuss precautions you would take when starting a patient on allopurinol. | Allopurinol 'should never be started within a month of an acute attack and always be started under cover of a course of NSAID or colchicine for the first 2–4 weeks before and 4 weeks after starting allopurinol, as it may induce acute gout'. K & C p532. |
| 1803 Mx of an acute attack of gout. | * NSAIDs - naproxen, diclofenac, indometacin In those with renal impairment or Hx of peptic ulceration, alternatives include: *Colchine * Corticosteroids. K & C p531. |
| 1799 In pseudogout, shedding of crystals into a joint precipitates acute s..... which resembles gout, except that it is more common in elderly ..... and usually affects the ..... or ..... The attacks are often very painful. In young people it may be associated with haemochromatosis, hyperparathyroidism, Wilson’s disease or alkaptonuria. | In pseudogout shedding of crystals into a joint precipitates acute synovitis which resembles gout, except that it is more common in elderly women and usually affects the knee or wrist. The attacks are often very painful. In young people it may be associated with haemochromatosis, hyperparathyroidism, Wilson’s disease or alkaptonuria. K & C p532. |
| 1792 ? | Gout with tophi. K & C p532. |
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