A disease characterized by precipitation of uric acid crystals in particular tissue?

NHM UP Staff Nurse - 2016

Medical & Surgical Nursing

Easy

Appeared in: NHM UP Staff Nurse - 2016

Explanation

Gout is a metabolic disorder characterized by hyperuricemia, which is an excess of uric acid in the blood.
This excess uric acid leads to the precipitation of monosodium urate crystals in joints and other tissues.
The body's immune system mounts an intense inflammatory response to these crystals, causing acute arthritis attacks with severe pain, swelling, and redness.
The classic presentation is an acute attack in the first metatarsophalangeal joint (big toe), known as podagra.

Option A: Rheumatoid arthritis is an autoimmune disorder where the body's immune system mistakenly attacks the synovial lining of the joints. It is not caused by uric acid crystal deposition.
Option C: Osteoarthritis is a degenerative joint disease caused by the mechanical 'wear and tear' of cartilage over time. It does not involve uric acid crystals.
Option D: Rheumatic fever is an inflammatory condition that can occur after a streptococcal infection. The associated arthritis is migratory and part of a systemic post-infectious syndrome, not caused by crystal deposition.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Pathophysiology of different types of arthritis in acute care settings.
Nurses play a crucial role in managing acute gout attacks by administering anti-inflammatory medications (like NSAIDs or colchicine), applying ice, and elevating the affected joint to reduce pain and swelling.
Patient education is key for long-term management. This includes teaching about dietary modifications (limiting high-purine foods like red meat and seafood, and reducing alcohol intake), maintaining hydration, and the importance of adhering to urate-lowering therapy (e.g., allopurinol).
What if the patient also has chronic kidney disease (CKD)? CKD significantly impairs the body's ability to excrete uric acid, making hyperuricemia and gout more likely and severe. Medication choices, particularly NSAIDs, must be carefully considered due to the risk of further kidney damage.

How to Approach the Question

First, identify the core concept in the question stem. The key phrase here is 'precipitation of uric acid crystals'.
Next, systematically review each option and recall its underlying pathophysiology.
For Option A (Rheumatoid arthritis), recall that it's an autoimmune condition.
For Option B (Gout), connect it directly to its definition as a crystal-deposition arthropathy caused by uric acid.
For Option C (Osteoarthritis), remember it's a degenerative 'wear-and-tear' disease.
For Option D (Rheumatic fever), link it to a post-streptococcal inflammatory response.

Concept Tested & Keywords

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E6 Pathology- ROBBINS & COTRAN PATHOLOGIC BASIS OF DISEASE 10TH Ed p. 1203-1205

E6 Medicine Harrison 22e Part 2 p. 860-862

E6 Textbook of Biochemistry for medical StudentsDM Vasudevan Part 2 — Subpart A (pp 1-239 of 478) p. 224-226