Crystalline Arthropathy
A 58-year-old man presents with acute onset severe pain, swelling, and erythema of his right first MCP joint. He has a history of hypertension treated with hydrochlorothiazide and chronic kidney disease stage 3. Examination reveals an exquisitely tender, erythematous, swollen first MCP with overlying skin appearing "shiny." He is afebrile. Serum uric acid is 9.2 mg/dL. Joint aspiration yields cloudy fluid with negatively birefringent needle-shaped crystals under polarized light microscopy. Regarding gout affecting the hand:
Mark each as TRUE or FALSE
Gout is caused by MONOSODIUM URATE (MSU) crystal deposition; crystals are NEEDLE-SHAPED and NEGATIVE...
ACUTE GOUT treatment: NSAIDs (indomethacin 50mg TDS) first-line if no contraindications; COLCHICINE ...
Gout crystals are positively birefringent and rhomboid-shaped; serum uric acid is always elevated du...
URATE-LOWERING THERAPY (ULT) indications: recurrent attacks (2 or more per year), TOPHI, chronic gou...
TOPHI are collections of MSU crystite deposits surrounded by granulomatous reaction; appear as firm,...
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Click T (True) or F (False) for each option