Gout Assignment
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finished, fax your answers to TLC along with the Registration Form and Customer
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Page on TLC’s website under the Assistance Page.
1. What is the diagnosis of the
photograph?
Gouty tophi
2. What blood test would you
perform?
Serum uric acid
3. What ocular signs may be
present?
Conjunctivitis
4. Give two medications that are available to lower serum uric acid levels.
Probencid can be given to patients with decreased clearance of uric acid from the
kidney. Patients must have documented decrease in urine uric acid and have a
creatinine clearance >40 cc/min.
Allopurinol can be used in patients who either have decreased clearance of uric acid or
elevated synthesis of uric acid.
5. Identify this medication? Allopurinol
* xanthine oxidase inhibitor
* prevents production of uric acid
* useful in both patients with increased synthesis and decreased clearance of uric acid
* no 24 hour urine needed
* can be used in renal failure
* rarely associated with bone marrow suppression, hepatotoxicity, and hypersensitivity
reactions
6. Identify this medication? Probenecid
* uricosuric
* decreases uric acid reabsorption at the proximal renal tubules
* useful in patients with decreased renal clearance of uric acid
* can only be used if creatinine clearance >40 cc/min
* must have 24 hour urine for uric acid <800 mg/dl
* can be used in renal failure
* increased risk of renal stones
7. Identify two historical figures that suffered with Gout?
Thomas Sydenham’s Benjamin Franklin
Fill-in-the-Blank Section
8. Purines: Components of all human tissue that break down to form uric acid. Purines
are also found in many foods in varying amounts.
9. Arthritis: Literally means joint inflammation. It is a general term for more than 100
conditions known as rheumatic diseases. These diseases affect not only the joints, but
also other parts of the body, including important supporting structures, such as muscles,
tendons, and ligaments, as well as some internal organs.
10. Uric acid: An organic substance that results from the breakdown of purines or waste
products in the body. It is dissolved in the blood and passes through the kidneys into the
urine, where it is eliminated. Most patients with gout have high levels of uric acid in their
blood. If the concentration of uric acid in the tissues rises above normal levels, crystals
can form in the joints and cause inflammation.
11. Uric acid crystals: Caused by high concentrations of uric acid. When uric acid
crystals form in the blood, they can collect in connective tissue, joints, and kidneys.
Some kidney stones are made of uric acid.
12. Joint: A junction where two bones meet. Most joints are composed of cartilage, joint
space, fibrous capsule, synovium, and ligaments.
13. Rheumatic diseases: A general term that refers to more than 100 conditions that
affect joints, muscles, bones, and other connective tissues.
14. Synovial fluid: A substance found around the joints that nourishes and lubricates
them.
15. Tendons: Fibrous cords of tissue that connect muscle to bone.
16. Connective tissue: The supporting framework of the body and its internal organs.
17. Corticosteroids: Potent anti-inflammatory hormones that are made naturally in the
body or synthetically for use as drugs. The most commonly prescribed corticosteroid is
prednisone.
18. Joint space: The volume enclosed within the fibrous capsule.
19. Ligaments: Bands of cordlike tissue that connect bone to bone.
20. Nonsteroidal anti-inflammatory drugs (NSAID`s): A group of drugs, such as aspirin
and aspirin-like drugs, used to reduce the inflammation that causes joint pain, stiffness,
and swelling.
21. Cartilage: A tough, resilient tissue that covers and cushions the ends of the bones
and absorbs shock.
22. Colchicine: A medicine used to treat gout. It may be given by mouth (orally) or
injected directly into a vein (intravenously).
23. Gout: A type of arthritis caused by the body’s reaction to needle-like crystals that
accumulate in joint spaces. This reaction causes inflammation and extreme pain in the
affected joint, most commonly the big toe. The crystals are formed from uric acid. Gout is
caused by either increased production of uric acid or failure of the body to eliminate uric
acid.
24. Hyperuricemia: Increased amount of uric acid in the blood.
25. Inflammation: A characteristic reaction of tissues to injury or disease. It is marked by
four signs: swelling, redness, heat, and pain.
26. Tophus (plural tophi): A hard deposit of crystalline uric acid that may appear as a
lump just under the skin, particularly around the joints and at the rim of the ear.
27. Crystal-induced arthritis: An accumulation of crystalline material in various parts of
the body, especially the joints. Gout and pseudogout are examples of crystal- induced
arthritis.
28. Pseudogout: Similar to gout; however, the crystals in the synovial fluid are
composed of calcium pyrophosphate dihydrate and not uric acid. As in gout, the crystals
in the joint space cause an intense inflammatory reaction in the joint.
True or False Statements
29. Gouty arthritis attacks can be precipitated by organic tissue becomes hardened by
the deposition of lime salts in the tissues.
A. True
B. False
30. The most reliable diagnostic test for gout is the identification of crystals in joints,
body fluids and tissues.
A. True
B. False
31. The treatment of an attack of gouty arthritis is the same treatment as hyperuricemia.
A. True
B. False
32. Painful gouty arthritis is caused by mineral deposits in joint tissue.
A. True
B. False
33. The tendency to develop gout and elevated blood uric acid level (hyperuricemia) is
often inherited.
A. True
B. False
34. Gout and hyperuricemia can be promoted by obesity, weight gain, alcohol intake,
high blood pressure, abnormal kidney function, and drugs.
A. True
B. False
35. Gout is condition characterized by characterized by attacks of pain, progressive
ataxia, loss of reflexes, functional disorders of the bladder, larynx, and gastrointestinal
system, and impotence an overload of uric acid in the body and recurring attacks of joint
inflammation (arthritis).
A. True
B. False
36. Chronic gout can lead to deposits of hard lumps osteofibrous material through which
the flexor tendons and the median nerve pass.
A. True
B. False
37. Gout has the unique distinction of being one of the most frequently recorded
medical illnesses throughout history. It is often related to an inherited abnormality in the
body's ability to process uric acid.
A. True
B. False
38. Uric acid is a breakdown product of purines, that are part of many foods we eat.
A. True
B. False
39. An abnormality in handling uric acid can cause attacks of painful arthritis (gout
attack), kidney stones, and costal cartilages of the ribs, the nasal septum, in the external
ear and lining the Eustachian tube.
A. True
B. False
40. On the other hand, some patients may only develop elevated blood uric acid levels
(hyperuricemia) without having arthritis or kidney problems.
A. True
B. False
41. The term "gout" commonly is used to refer to the deposition of calcium in chronically
inflamed tendon, esp. the tendons of the shoulder painful arthritis attacks.
A. True
B. False
42. Gouty arthritis is usually an extremely painful attack with a rapid onset of joint
inflammation.
A. True
B. False
43. The joint inflammation is precipitated by deposits of uric acid crystals in the joint fluid
(synovial fluid) and joint lining (synovial lining). Intense joint inflammation occurs as
white blood cells engulf the uric acid crystals and release chemicals of inflammation,
causing pain, heat, and redness of the joint tissues.
A. True
B. False
44. Patients can develop fever with the acute gout attacks. These painful attacks usually
subside in hours to days, with or without medication.
A. True
B. False
45. In rare instances, a gout attack can last for years.
A. True
B. False
46. Most patients with gout will experience repeated attacks of arthritis over the years.
A. True
B. False
47. Approximately one million people in the United States suffer from attacks of gout.
A. True
B. False
48. Gout is nine times more common in men than in women.
A. True
B. False
49. Gout predominantly attacks males after puberty, with a peak age of 50. In women,
gout attacks usually occur before menopause.
A. True
B. False
50. While an elevated blood level of uric acid (hyperuricemia) may indicate an increased
risk of gout, the relationship between hyperuricemia and gout is unclear. All patients with
hyperuricemia will surely develop gout, while some patients with repeated gout attacks
have normal or low blood uric acid levels.
A. True
B. False
Final Assignment
Write a complete 5 day diet for a 40 year old male that has gout. This patient has eaten
mostly Mexican food and pizza most of his life. Lots of cheese and grease. Plan each
meal in detail.