NGR 6200 EXAM 4 2024/2025( UPDATED)COMPLETE ACTUAL EXAM
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)
ALREADY GRADED A+.
What is a metabolic disease that produces an inflammatory arthritis
including overproduction (90%) or under excretion (or both) of uric
acid? - ANSWER-Gout
Gout risk factors include: - ANSWER-Men ages 40-50, black, obese,
diabetes mellitus, and family history, persons from countries with
abundant lifestyles
Name medications can precipitate gout? - ANSWER-Thiazide
diuretics, niacin, aspirin, and cyclosporine can precipitate gout by
causing hyperuricemia
Are there medications that are not specifically designed for gout, but
are beneficial? - ANSWER-Losartan (ARB) and fenofibrate are
considered uricosuric
Name conditions that can precipitate gout. - ANSWER-ETOH use,
psoriasis, myeloproliferative and lymphoproliferative disease, chronic
hemolytic anemia, and conditions with decreased renal uric acid
clearance such as intrinsic kidney disease and renal failure.
What is the most accurate diagnostic test for acute gouty arthritis? -
,ANSWER-Analysis of joint aspirate for urate crystals is diagnostic
What is the clinical presentation of acute gout? - ANSWER-Recurrent,
painful attacks of monoarticular joint inflammation, pain, tenderness,
erythema, and swelling, Excruciating pain that awakens the patient at
night, describing the pain as throbbing, crushing, and pulsating, not
relieved by rest or position change, often in early morning due to
dehydration. These patients often present to the office on crutches
Name other conditions that can mimic gout that should be in your
differentials. - ANSWER-Acutely infected joint (gout is 100 times more
common than monoarticular septic arthritis)
Nontender and firm nodules that develop in soft tissue with repeated
gout episodes are called? - ANSWER-Tophi
Where are the common locations for tophi? - ANSWER-External ear
(cooler areas), auricles, elbows, exterior surface of the hands
Which labs are obtained during a gouty flare? - ANSWER-Initial uric
acid as a baseline is helpful although it may be normal or low during a
flare. CRP and ESR are elevated but these are neither sensitive nor
specific for gout
Are radiographs needed to assess a patient with suspected gout? -
ANSWER-Only if there is a concurrent history of trauma and risk of
fracture
,What condition presents similar to gout but is caused by the presence
of calcium pyrophosphate dehydrate crystals in the joints? -
ANSWER-Pseudogout (Calcium pyrophosphate deposition CPPD)
Name conditions that are associated with pseudogout. - ANSWER-
Hypothyroidism or hyperparathyroidism, hemochromocytosis
What labs might be obtained if pseudogout is suspected to rule out
metabolic conditions associated with pseudogout? - ANSWER-TSH,
calcium, magnesium, PTH, CBC, iron studies
What is the goal of treatment for Pseudogout? - ANSWER-Primarily to
relieve pain, improve joint function and includes the use of NSAIDs,
colchicine, and oral corticosteroids within 24 hours of attack
Name the anti -inflammatory drugs used to treat an acute attack of
gout - ANSWER-NSAIDs, glucocorticoids, and colchicine are used to
treat an attack of gout
Is aspirin precipitate gout? - ANSWER-Yes
Why is it important to avoid rapid reduction in serum uric acid? -
ANSWER-It can make the episode worse
A loading dose of naproxen_____mg followed by lower doses is
recommended (Fitzgerald 2017) - ANSWER-750 mg
, What is the recommended dosage of colchicine for a gouty flare? -
ANSWER-1.2 mg initially, then 0.6 mg one hour later followed by 0.6
mg once or twice a day for 5-10 days then taper for 7-10 days
(Fitzgerald 2017
What are the adverse effects of colchicine? - ANSWER-Nausea,
vomiting, severe diarrhea, and abdominal pain.
True or False? If GI symptoms occur, colchicine should be stopped
immediately regardless the status of joint pain - ANSWER-True
The FDA recently revised the old dosing of a drug for gout that was
directed to be given 0.6 mg 2 tabs then one tab every hour until pain
subsides or GI toxicity occurs to treat gout. Over a hundred deaths
have occurred and the new dosing advised by the FDA is 2 tabs
followed by one tab an hour later. The drug is____________? -
ANSWER-Colchicine
If colchicine is not tolerated what is an alternative for a gouty flare? -
ANSWER-Prednisone 0.5 mg/kg/day for 5-10 days
If a patient is on warfarin, has CKD or PUD, what treatments could be
used for a gouty flair? - ANSWER-Local injection with corticosteroids
Allopurinol, febuxostat & probenecid are used to reduce uric acid
levels. These drugs are not used in acute gouty attacks. True or
