Part 6.4-INFLAMMATION-GOUT

Proverbs 16:3

d. Metabolic disorder

Gout is classified as a:
a. Autoimmune disorder
b. Neurologic disorder
c. Infectious disease
d. Metabolic disorder

a. Monosodium urate (MSU) crystals in tissues

Gout is characterized by increased deposition of:
a. Monosodium urate (MSU) crystals in tissues
b. Calcium oxalate crystals
c. Cholesterol crystals
d. Platelets in vessels

b. Increased total uric acid in the body

Hyperuricemia refers to:
a. Low uric acid in the body
b. Increased total uric acid in the body
c. Increased calcium levels
d. Low blood glucose

a. Cardinal signs of inflammation (Rubor, tumor, calor, dolor functio laesa)

Acute gouty arthritis commonly presents with:
a. Cardinal signs of inflammation
b. Bradycardia only
c. Respiratory depression
d. Hyperglycemia

b. Monoarticular involving one joint

Acute gout is usually:
a. Polyarticular in all patients
b. Monoarticular involving one joint
c. Non-inflammatory
d. Symmetrical in both hands

d. First metatarsophalangeal joint

The most commonly affected joint in acute gout is the:
a. Shoulder joint
b. Knee joint
c. Hip joint
d. First metatarsophalangeal joint

c. Polyarticular arthritis

In elderly women, gout commonly presents as:
a. Monoarticular disease
b. CNS disease
c. Polyarticular arthritis
d. Pulmonary disease

a. Subcutaneous deposit of MSU crystals

A tophus in chronic gout refers to:
a. Subcutaneous deposit of MSU crystals
b. Uric acid stone in the urinary tract
c. Destructive lesion causing joint deformity
d. Calcified deposit within cartilage

b. Chronic kidney disease

A gouty nephropathy in chronic gout refers to:

a. Acute liver failure
b. Chronic kidney disease
c. Acute Kidney Infection
d. Heart failure

b. Uric acid stones

Chronic gout is associated with formation of:
a. Gallstones only
b. Uric acid stones
c. Cholesterol emboli
d. Calcium plaques

I. Pain control

II. Anti-inflammatory

Acute gout goals

I. Pain control

II. Anti-inflammatory

III. Hypouricemic therapy

III. Hypouricemic therapy

Chronic gout goals

I. Pain control

II. Anti-inflammatory

III. Hypouricemic therapy

a. NSAIDs (except aspirin and salicylates)

[Acute Gout]

Which drug class is commonly used for pain control in acute gout?
a. NSAIDs
b. Nacrotics
c. Anticoagulants
d. Antihistamines

b. Short-acting and lipid-soluble

[Acute Gout]

The drug of choice NSAID for acute gout is generally:
a. Long-acting and water-soluble
b. Short-acting and lipid-soluble
c. Non-lipid soluble
d. COX-2 selective

a. Indomethacin

[Acute Gout]

Which NSAID is commonly used in acute gout?
a. Indomethacin
b. Warfarin
c. Celecoxib
d. Acetaminophen

b. Ibuprofen

[Acute Gout]

Which NSAID is commonly used in acute gout?
a. Mefenamic Acid
b. Ibuprofen
c. Celecoxib
d. Acetaminophen

d. Diclofenac

[Acute Gout]

Which NSAID is commonly used in acute gout?
a. Mefenamic Acid
b. Paracetamol
c. Celecoxib
d. Diclofenac

b. Inhibiting microtubule synthesis

[Acute Gout]

Colchicine MOA
a. Blocking COX-2 only
b. Inhibiting microtubule synthesis
c. Increasing uric acid excretion
d. Blocking histamine receptors

a. Aplastic anemia, hemolytic anemia, thrombocytopenia

[Acute Gout]

Which adverse effect may occur with colchicine?
a. Aplastic anemia, hemolytic anemia, thrombocytopenia
b. Hyperglycemia, hemolytic anemia, thrombocytopenia
c. Cataracts, hyperglycemia, and hemolytic anemia
d. Hypertension, hyperglycemia, and hemolytic anemia

a. Acute hepatitis and renal failure

[Acute Gout]

Which organ toxicities may be caused by colchicine?
a. Acute hepatitis and renal failure
b. Lung fibrosis and renal failure
c. Retinal damage and respiratory depression
d. Heart block and lung fibrosis

b. Bl00dy diarrhea

[Acute Gout]

A characteristic gastrointestinal toxicity of colchicine is:
a. Constipation only
b. Bl00dy diarrhea
c. Dry mouth
d. Vomiting blood

b. Diarrhea

[Acute Gout]

The first sign of colchicine toxicity is usually:
a. Headache
b. Diarrhea
c. Hypertension
d. Jaundice

a. Elderly patients and those with renal failure

[Acute Gout]

Colchicine is contraindicated in:
a. Elderly patients and those with renal failure
b. Children
c. Healthy adults
d. Patients with fever and viral infection

a. Prednisone

[Acute Gout]

Which oral glucocorticoid may be used in acute gout?
a. Prednisone
b. Warfarin
c. Aspirin
d. Methotrexate

b. Polyarticular arthritis in elderly patients

[Acute Gout]

Prednisone is commonly used in acute gout for:
a. Monoarticular arthritis in elderly patients
b. Polyarticular arthritis in elderly patients
c. Cholesterol lowering
d. Renal stone dissolution

a. IM adrenocorticotropic hormone (ACTH)

[Acute Gout]

Which injectable therapy may be used for refractory polyarticular acute gout in elderly patients with renal failure?
a. IM adrenocorticotropic hormone (ACTH)
b. IV heparin
c. IV glucocorticoids
d. Aspirin

b. Decrease serum uric acid to <300–360 mmol/L

[Chronic Gout]

The main goal of hypouricemic therapy in chronic gout is to:
a. Increase serum uric acid to <300–360 mmol/L
b. Decrease serum uric acid to <300–360 mmol/L
c. Decrease serum uric acid to <100–150 mmol/L
d. Increase serum uric acid to <100–150 mmol/L

d. Acute attacks more than 2 times

[Chronic Gout]

Hypouricemic therapy is indicated in patients with:
a. One gout attack
b. Mild fever and inflammation
c. Viral infection more than 2 times
d. Acute attacks more than 2 times

d. Stable doses of colchicine without flares for at least 2–3 weeks

[Chronic Gout]

Before starting chronic gout hypouricemic therapy, patients should have:
a. Active flare of gout
b. Controlled comorbidities such as hypertension or diabetes
c. Requirement of thrombocytosis (elevated platelet count)
d. Stable doses of colchicine without flares for at least 2–3 weeks

b. Commitment for long-term therapy

[Chronic Gout]

Chronic gout therapy requires:
a. Short-term treatment
b. Commitment for long-term therapy
c. Single-dose therapy
d. Emergency treatment

a. Probenecid

[Chronic Gout]

only uricosuric agent commonly used in chronic gout
a. Probenecid
b. Allopurinol
c. Colchicine
d. Prednisone

c. <600 mg/day

[Chronic Gout]

Probenecid is indicated when urine uric acid is:
a. >1000 mg/day
b. >500 mg/day
c. <600 mg/day
d. <100 mg/day

a. Urate stone formation

[Chronic Gout]

A major adverse effect of probenecid is:
a. Urate stone formation
b. GI bleeding
c. Respiratory depression
d. Hyperglycemia

b. 1.5 L/day

[Chronic Gout]

Patients taking probenecid should maintain water intake of at least:
a. 500 mL/day
b. 1.5 L/day
c. 3.5 L/day
d. 5 L/day

a. Sulfinpyrazone and Penicillamine

[Chronic Gout]

Which of the following are uricosuric agents?
a. Sulfinpyrazone and Penicillamine
b. Colchicine and Indomethacin
c. Morphine and Codeine
d. Allopurinol and Acetaminophen

b. Allopurinol

[Chronic Gout]

Which drug blocks xanthine oxidase to inhibit uric acid formation?
a. Colchicine
b. Allopurinol
c. Prednisone
d. Probenecid

c. Blockade of xanthine oxidase to inhibit uric acid formation

[Chronic Gout]

The mechanism of allopurinol is:
a. Inhibition of microtubule synthesis
b. COX inhibition
c. Blockade of xanthine oxidase to inhibit uric acid formation
d. Decrease serum uric acid

a. Severe hyperuricemia

[Chronic Gout]

Allopurinol may also be used in management of:
a. Severe hyperuricemia
b. Viral fever only
c. Osteoporosis
d. Hypertension only

a. Urate stone formation

[Chronic Gout]

Allopurinol helps reduce the risk of:
a. Urate stone formation
b. Inflammation
c. GI bleeding
d. Arrhythmia

a. Tumor lysis syndrome

[Chronic Gout]

May be prevented or managed with allopurinol
a. Tumor lysis syndrome
b. Bronchial asthma
c. Migraine
d. Osteoarthritis

b. Rash or SJS/TEN

[Chronic Gout]

A serious dermatologic adverse effect of allopurinol is:
a. Acne
b. Rash or SJS/TEN
c. Alopecia
d. Photosensitivity

b. Aplastic anemia

[Chronic Gout]

adverse effect of allopurinol
a. Polycythemia
b. Aplastic anemia
c. Thrombocytosis
d. Leukocytosis

a. Hepatitis and renal failure

[Chronic Gout]

May occur with allopurinol
a. Hepatitis and renal failure
b. Pulmonary fibrosis
c. Hyperthermia
d. Bone necrosis

b. Chronic gout and hyperuricemia

[Chronic Gout]

Febuxostat is primarily used in the management of:
a. Acute pulmonary edema
b. Chronic gout and hyperuricemia
c. Osteoarthritis
d. Acute gout

a. Cannot tolerate allopurinol

[Chronic Gout]

Febuxostat is commonly used when a patient:
a. Cannot tolerate allopurinol
b. Has mild fever only
c. Needs anticoagulation
d. Requires antiplatelet therapy

b. Not associated with SJS/TEN

[Chronic Gout]

An advantage of febuxostat over allopurinol is that it is:
a. More potent analgesic
b. Not associated with SJS/TEN
c. Safer in CAD
d. Free from all adverse effects

a. Increased cardiovascular mortality

[Chronic Gout]

A major adverse effect of febuxostat is:
a. Increased cardiovascular mortality
b. Severe respiratory depression
c. GI ulceration only
d. Hyperglycemia only

a. Myocardial infarction

[Chronic Gout]

Febuxostat increases the risk of:
a. Myocardial infarction
b. Renal stone dissolution
c. Bronchodilation
d. Platelet destruction

d. Coronary artery disease (CAD)

[Chronic Gout]

Febuxostat is contraindicated in patients with:
a. Asthma
b. Viral infection
c. Osteoarthritis
d. Coronary artery disease (CAD)

c. Facilitate conversion of urate to a more soluble product, allantoin

[Chronic Gout]

Xanthine oxidase inhibitors MOA

a. Block prostaglandin synthesis
b. Blocks xanthine oxidase to inhibit uric acid formation
c. Facilitate conversion of urate to a more soluble product, allantoin
d. Inhibit microtubule synthesis

c. A more soluble product of urate metabolism

[Chronic Gout]

Allantoin is important because it is:
a. Less soluble than urate
b. A platelet aggregant
c. A more soluble product of urate metabolism
d. An inflammatory mediator

a. Pegloticase

-Rasburicase

[Chronic Gout]

Recombinant urate oxidase/ Xanthine oxidase inhibitors

a. Pegloticase
b. Colchicine
c. Prednisone
d. Ibuprofen

b. Refractory gout

[Chronic Gout]

Pegloticase is used for patients with:
a. Mild fever
b. Refractory gout
c. Acute pulmonary edema
d. Osteoarthritis

d. G6PD deficiency

[Chronic Gout]

Pegloticase is contraindicated in patients with:
a. Hypertension
b. CAD
c. Osteoporosis
d. G6PD deficiency

a. Rasburicase

[Chronic Gout]

Which recombinant urate oxidase is used in patients at risk of tumor lysis syndrome?
a. Rasburicase
b. Allopurinol
c. Febuxostat
d. Probenecid

b. Management of elevated uric acid levels

[Chronic Gout]

Rasburicase is commonly used for:
a. Pain control
b. Management of elevated uric acid levels
c. Platelet inhibition
d. Inflammation

d. Hemolytic anemia

[Chronic Gout]

A major adverse effect of recombinant urate oxidase therapy is:
a. GI bleeding
b. Aplastic anemia
c. SJS
d. Hemolytic anemia