Question 1

Which of the following statements about uric acid is true?&#10;A) It is a product of pyrimidine-based nucleic acid metabolism.&#10;B) It tends to crystallise at relatively low physiological temperatures.&#10;C) Hyperuricaemia always results in gout.&#10;D) Uric acid is very water-soluble in kidney filtrate.

Accepted Answer

Uric acid tends to crystallize at relatively low physiological temperatures, which is a factor in the development of gout, as these crystals can deposit in joints and tissues, causing inflammation and pain. Uric acid is actually a product of purine metabolism, not pyrimidine. Hyperuricemia, or high levels of uric acid in the blood, does not always result in gout; many people with elevated uric acid levels never develop gout symptoms. Lastly, uric acid is not very water-soluble in kidney filtrate, which contributes to its potential to crystallize and cause problems.

Question 2

Which of the following tests is undertaken before using colchicine for gout prophylaxis?&#10;A) A complete blood count&#10;B) A liver function test&#10;C) An electrocardiogram&#10;D) An exercise tolerance test

Accepted Answer

A complete blood count is necessary before using colchicine for gout prophylaxis as it can cause bone marrow suppression and leukopenia. Liver function test, electrocardiogram, and exercise tolerance test are not specifically required for colchicine use in gout prophylaxis.

Question 3

When commencing a uricosuric agent such as probenecid,the person should be advised to:&#10;A) cease all other medications to reduce drug interactions.&#10;B) ensure adequate fluid intake to reduce kidney stone formation.&#10;C) avoid direct sunlight.&#10;D) avoid urine alkalising preparations.

Accepted Answer

Uricosuric agents increase the excretion of uric acid in urine, which can increase the risk of kidney stone formation. Therefore, the person should be advised to ensure adequate fluid intake to prevent this side effect.

Question 4

A characteristic of gout is that:&#10;A) it manifests as a form of arthritis.&#10;B) it is more prevalent in women.&#10;C) the risk of developing it can be reduced by eating foods such as sardines or offal.&#10;D) it is not associated with any genetic predisposition.

Accepted Answer

Gout is a form of arthritis that is caused by a buildup of uric acid crystals in the joints. Symptoms include sudden and severe pain, redness, and swelling in the affected joint. It is not more prevalent in women, and the risk of developing it can actually be increased by eating foods high in purines, such as sardines or offal. There is also a genetic component to gout, with some people being more predisposed to developing it than others.

Question 5

To minimise the increased incidence of acute gouty attacks at the start of allopurinol treatment,________ should be given concurrently for the first two months of treatment.&#10;A) colchicine or an NSAID&#10;B) probenecid&#10;C) an intra-articular injection of methylprednisolone&#10;D) a urinary alkaliser such as sodium bicarbonate

Accepted Answer

Concurrent administration of colchicine or an NSAID for the first two months of allopurinol treatment can reduce the likelihood of acute gouty attacks. Both these drugs have anti-inflammatory effects that can help manage and prevent gout flares. Probenecid and urinary alkalizers are not recommended for use in acute gout flares. Intra-articular injection of methylprednisolone may be considered in patients with severe acute gouty arthritis, but it is not a standard part of gout management during allopurinol initiation.

Question 6

Prior to commencing probenecid for gout,it is important to inform the person that:&#10;A) probenecid is inactivated by pigments in red food colouring, so they must abstain from foods containing red dye three days prior to commencement of therapy and throughout the course of therapy.&#10;B) probenecid is likely to cause constipation.&#10;C) ceasing oral analgesics is the best way to gauge the effect of a course of probenecid.&#10;D) probenecid is a preventive treatment and should not be commenced while they have acute symptoms of gout.

Accepted Answer

It is important to inform the person that probenecid is a preventive treatment and should not be commenced while they have acute symptoms of gout. This is because probenecid works by reducing the uric acid concentration in the blood over a longer period of time, and is not effective at treating the immediate symptoms of gout. It is also important to note that probenecid may interact with other medications, so the person should inform their healthcare provider of all medications they are taking before starting probenecid.

Question 7

Colchicine has NSAID properties,but also has specific mechanisms including ________ to treat gout.&#10;A) stimulating prostaglandin synthesis and secretion&#10;B) disruption of leukocyte microtubule function, which inhibits cell migration to the site of inflammation&#10;C) activation of xanthine oxidase&#10;D) creating more acidic urine, which increases excretion of uric acid

Accepted Answer

Colchicine works by inhibiting leukocyte microtubule function, which reduces inflammation in the affected joint during a gout attack. This mechanism is independent of the NSAID properties of the drug. Choice A is incorrect because colchicine does not stimulate prostaglandin synthesis and secretion. Choice C is incorrect because xanthine oxidase activation would lead to increased uric acid production and worsen gout symptoms. Choice D is incorrect because colchicine does not affect urine acidity or uric acid excretion.

Question 8

Which one of the following drugs or drug groups acts to increase the excretion of uric acid?&#10;A) The corticosteroids&#10;B) Colchicine&#10;C) Probenecid&#10;D) Allopurinol

Accepted Answer

Probenecid is a uricosuric agent that works by increasing the excretion of uric acid by the kidneys. The other drugs listed, corticosteroids, colchicine, and allopurinol, do not increase uric acid excretion but rather work by different mechanisms to reduce uric acid levels in the body. Corticosteroids and colchicine are used to treat acute gout attacks, while allopurinol is a xanthine oxidase inhibitor that reduces uric acid production in the body.

Deck 65: Hyperuricaemia and Gout