CAM Exam 3
What med most commonly causes secondary gout? - ANS HCTZ
Who is primary gout most common in? - ANS men ages 30-50
M:W --> 9:1
What chronic illness is a common cause of secondary gout? - ANS CKD
What is the term for gout affecting the MTP of the great toe? - ANS podagra
Gout is associated w acute onset of severe __________ arthritis.
A - monoarticular
B - oligoarticular
C - polyarticular
D - axial skeleton - ANS A - monoarticular
How do you confirm a dx of gout? - ANS synovial fluid analysis --> rod or needle shaped negatively
birefringent urate crystals
48 y/o male presents to clinic complaining of pain at the base of his big toe. On PE, you note swelling &
redness at the MTP of the great toe. You order an x-ray of the foot to see what is going on & note rat
bite looking lytic lesions. Pt's only PMHx is HTN in which he takes a thiazide diuretic. What is your
suspected dx? - ANS gout
,You perform a joint fluid analysis on a painful, red, & swollen MTP of great toe & find rod/needle shaped
negatively birefringent urate crystals. What is your dx? - ANS gout
What is the 1st line tx for an acute attack of gout? - ANS NSAIDs --> Naproxen 500 mg BID x 5-7 days
**NO ASPIRIN**
55 y/o male is having an acute flare of gout in his big toe. Pt has active PUD & is being manage by his GI
specialist. What should you tx this pt w to manage his gout sx? - ANS prednisone 40-60 mg/day x 7 days
+/-
Colchicine
**PUD = NSAIDs contraindication**
What are prophylactic tx options for gout? - ANS colchicine
and/or
allopruinol or febuxostat (xanthine oxidase inhibitors)
You perform a joint aspiration on a pt that has been dealing w episodic arthritis in their knees. It shows
weakly positive birefringent calcium pyrophosphate crystals (rhomboid shaped). What is your dx & tx
plan for acute flares? - ANS pseudogout
NSAIDs
,What x-ray finding do you see in nearly all pts w pseduogout? - ANS chondocalcinosis
What are 2 big risk factors for RA? - ANS female & smoking
What antibodies are used to help dx rheumatoid arthritis? - ANS rheumatoid factor (Rh) & anti-CCP
Which antibody is the MOST specific to rheumatoid arthritis? - ANS anti-CCP
36-year-old woman who comes to your office with a 6-month history of malaise, paresthesia in both
hands, and vague pain in both hands and wrists. She also has felt extremely fatigued. She tells you that
the pains in her joints are much worse in the morning and takes more than an hour to improve She is
also noticing pain and swelling in both knees. There is a sensation of bogginess and slight swelling in
both wrists and multiple MCP joints. Both knees also feel swollen and boggy. There are no other joint
abnormalities, and the rest of the physical examination is normal. Rheumatoid factor and anti-CCP are
positive. Radiographs of her hands show narrowed joint spaces and ulnar deviation. What is your
suspected dx & 1st line tx? - ANS RA
Methotrexate
You dx your pt w RA & prescribe them methotrexate. What needs to be supplemented while on this
med? - ANS folic acid 1 mg/day --> MTX inhibitors folic acid synthesis = risk of folate deficiency
What is the most characteristic sign of rheumatoid arthritis?
A-joint swelling
B-bilateral (symmetric) joint involvement
C-erythema surrounding the affected joints
D-joint bogginess
E-involvement of the glenohumeral joint in all cases - ANS B-bilateral (symmetric) joint involvement
, What type of finger deformity can be seen in pts w long term RA? - ANS swan neck deformity
PIP hyperextension & DIP flexion
When does juvenile idiopathic arthritis typically develop? - ANS > 6 months but < 16 years old
What is the most common form of juvenile idiopathic arthritis? - ANS oligoarticular = affects </= 4 joints
Pts w oligoarticular juvenile idiopathic arthritis are at an increased risk of developing what? - ANS uveitis
or iritis
What is the most common comorbidity w juvenile idiopathic arthritis? - ANS iridocyclitis = inflammation
of anterior chamber = blurry vision
14-year-old with complaints of morning stiffness and fatigue for the past 3 months. She complains of
worsening stiffness after periods of inactivity and finds it difficult to participate in sports, especially PE.
Her mom is particularly concerned because her daughter has been missing school and this has begun to
affect her academic performance. They are requesting a medical note to be dismissed from physical
education. Pt has been to other doctors & all malignant causes have been ruled out. What is your
suspected dx? - ANS juvenile idiopathic arthritis
A 12-year-old boy is brought in to your office by his mother and father. The child has been experiencing
swelling of his joints, fevers, and a rash. An examination reveals hepatosplenomegaly and
lymphadenopathy. Laboratory evaluation shows anemia, leukocytosis, and thrombocytosis. You suspect
juvenile rheumatoid arthritis (JRA). Which of the following medications would be first-line treatment? -
ANS NSAIDs
**this is a still's disease or systemic JIA presentation**
What med most commonly causes secondary gout? - ANS HCTZ
Who is primary gout most common in? - ANS men ages 30-50
M:W --> 9:1
What chronic illness is a common cause of secondary gout? - ANS CKD
What is the term for gout affecting the MTP of the great toe? - ANS podagra
Gout is associated w acute onset of severe __________ arthritis.
A - monoarticular
B - oligoarticular
C - polyarticular
D - axial skeleton - ANS A - monoarticular
How do you confirm a dx of gout? - ANS synovial fluid analysis --> rod or needle shaped negatively
birefringent urate crystals
48 y/o male presents to clinic complaining of pain at the base of his big toe. On PE, you note swelling &
redness at the MTP of the great toe. You order an x-ray of the foot to see what is going on & note rat
bite looking lytic lesions. Pt's only PMHx is HTN in which he takes a thiazide diuretic. What is your
suspected dx? - ANS gout
,You perform a joint fluid analysis on a painful, red, & swollen MTP of great toe & find rod/needle shaped
negatively birefringent urate crystals. What is your dx? - ANS gout
What is the 1st line tx for an acute attack of gout? - ANS NSAIDs --> Naproxen 500 mg BID x 5-7 days
**NO ASPIRIN**
55 y/o male is having an acute flare of gout in his big toe. Pt has active PUD & is being manage by his GI
specialist. What should you tx this pt w to manage his gout sx? - ANS prednisone 40-60 mg/day x 7 days
+/-
Colchicine
**PUD = NSAIDs contraindication**
What are prophylactic tx options for gout? - ANS colchicine
and/or
allopruinol or febuxostat (xanthine oxidase inhibitors)
You perform a joint aspiration on a pt that has been dealing w episodic arthritis in their knees. It shows
weakly positive birefringent calcium pyrophosphate crystals (rhomboid shaped). What is your dx & tx
plan for acute flares? - ANS pseudogout
NSAIDs
,What x-ray finding do you see in nearly all pts w pseduogout? - ANS chondocalcinosis
What are 2 big risk factors for RA? - ANS female & smoking
What antibodies are used to help dx rheumatoid arthritis? - ANS rheumatoid factor (Rh) & anti-CCP
Which antibody is the MOST specific to rheumatoid arthritis? - ANS anti-CCP
36-year-old woman who comes to your office with a 6-month history of malaise, paresthesia in both
hands, and vague pain in both hands and wrists. She also has felt extremely fatigued. She tells you that
the pains in her joints are much worse in the morning and takes more than an hour to improve She is
also noticing pain and swelling in both knees. There is a sensation of bogginess and slight swelling in
both wrists and multiple MCP joints. Both knees also feel swollen and boggy. There are no other joint
abnormalities, and the rest of the physical examination is normal. Rheumatoid factor and anti-CCP are
positive. Radiographs of her hands show narrowed joint spaces and ulnar deviation. What is your
suspected dx & 1st line tx? - ANS RA
Methotrexate
You dx your pt w RA & prescribe them methotrexate. What needs to be supplemented while on this
med? - ANS folic acid 1 mg/day --> MTX inhibitors folic acid synthesis = risk of folate deficiency
What is the most characteristic sign of rheumatoid arthritis?
A-joint swelling
B-bilateral (symmetric) joint involvement
C-erythema surrounding the affected joints
D-joint bogginess
E-involvement of the glenohumeral joint in all cases - ANS B-bilateral (symmetric) joint involvement
, What type of finger deformity can be seen in pts w long term RA? - ANS swan neck deformity
PIP hyperextension & DIP flexion
When does juvenile idiopathic arthritis typically develop? - ANS > 6 months but < 16 years old
What is the most common form of juvenile idiopathic arthritis? - ANS oligoarticular = affects </= 4 joints
Pts w oligoarticular juvenile idiopathic arthritis are at an increased risk of developing what? - ANS uveitis
or iritis
What is the most common comorbidity w juvenile idiopathic arthritis? - ANS iridocyclitis = inflammation
of anterior chamber = blurry vision
14-year-old with complaints of morning stiffness and fatigue for the past 3 months. She complains of
worsening stiffness after periods of inactivity and finds it difficult to participate in sports, especially PE.
Her mom is particularly concerned because her daughter has been missing school and this has begun to
affect her academic performance. They are requesting a medical note to be dismissed from physical
education. Pt has been to other doctors & all malignant causes have been ruled out. What is your
suspected dx? - ANS juvenile idiopathic arthritis
A 12-year-old boy is brought in to your office by his mother and father. The child has been experiencing
swelling of his joints, fevers, and a rash. An examination reveals hepatosplenomegaly and
lymphadenopathy. Laboratory evaluation shows anemia, leukocytosis, and thrombocytosis. You suspect
juvenile rheumatoid arthritis (JRA). Which of the following medications would be first-line treatment? -
ANS NSAIDs
**this is a still's disease or systemic JIA presentation**
