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Self-Assessment Questions

Rheumatology

Gout Arthropathy: Review Questions

Janet F. Burkholder, MD

Dr. Burkholder is an Assistant Professor of Medicine, Temple University Hospital, Philadelphia, PA.


Choose the single best answer for each question.

1. A 55-year-old man is referred to a rheumatologist for long-term management of gout. He had an episode of knee pain and swelling 2 weeks previously, and results of joint aspiration at that time were positive for uric acid crystals. Which of the following findings would warrant uric acid­lowering therapy?
  1. Creatinine level of 1.9 mg/dL
  2. Diabetes mellitus
  3. Severe first attack of gout
  4. Tophus of the elbow
  5. Uric acid level of 10.4 mg/dL
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2. A 70-year-old woman has symmetrical polyarthritis, which primarily involves her wrists and metacarpophalangeal joints. The presence of which of the following abnormalities would be most helpful in establishing a diagnosis of gout?

  1. Elevated erythrocyte sedimentation rate
  2. Negative rheumatoid factor
  3. Numbness in the index and middle fingers
  4. Sclerotic erosion on a radiograph of the hand
  5. Subcutaneous nodules
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3. A 62-year-old man with a long-standing history of gout comes to the emergency department because of a 2-day history of severely swollen knees. He is on a complex medical regimen to treat heart failure, and his diuretic dose was increased last week to manage progressive fluid retention. The only medication he is currently taking for gout is colchicine. Which of the following is the most appropriate next step in the management of his inflamed knees?

  1. Administer allopurinol 100 mg once daily
  2. Administer a 2-mg dose of colchicine, intravenously
  3. Administer indomethacin 50 mg 3 times daily
  4. Aspirate both knees and inject a corticosteroid solution
  5. Aspirate both knees and admit him to the hospital for intravenous treatment with antibiotics
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  4. Which of the following drug combinations is potentially dangerous in the treatment of gout?
  1. Allopurinol and azathioprine
  2. Colchicine and cyclosporine
  3. Indomethacin and nifedipine
  4. Prednisone and oral contraceptive agents
  5. Probenecid and lovastatin
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5. A 48-year-old man with a history of chronic lead exposure, untreated hypertension, and chronic tophaceous gout is seen by a nephrologist. His last measured creatinine clearance level was 32 mL/min. He is put on a multidrug regimen to treat his hypertension. Because he is allergic to allopurinol, his gout is managed with a regimen of colchicine 0.6 mg twice daily and intra-articular injection, as needed. For which of the following adverse effects of his medications is the patient most at risk?

  1. Aplastic anemia
  2. Dermatitis
  3. Hepatorenal syndrome
  4. Myopathy
  5. Peptic ulcer disease
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6. Which of the following can precipitate a gout attack?

  1. Administration of fluids during surgery
  2. Immobilization of a joint
  3. Initiation of hormone replacement therapy
  4. Prolonged exposure to warm temperatures
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