Uric acid crystal deposits under the skin in gout are known as:

Appeared in: DSSSB 14 August 2024

Explanation

Tophi are the characteristic lesions of chronic gout, formed by the deposition of monosodium urate (MSU) crystals in soft tissues.
These deposits occur when hyperuricemia (high blood uric acid) is prolonged and uncontrolled.
Tophi typically appear as firm, irregular, and sometimes yellowish nodules under the skin.
Common locations for tophi include the extensor surfaces of fingers, hands, elbows, Achilles tendons, and the helix of the ear.
Their presence signifies a high body burden of urate and indicates advanced disease.

Option A: Heberden's nodes are bony outgrowths (osteophytes) of the distal interphalangeal (DIP) joints of the fingers.
Option B: Erythema nodosum is an inflammation of the fat cells under the skin (panniculitis), resulting in tender red nodules, most commonly on the shins.
Option D: Erythema marginatum is a specific type of rash characterized by pink rings with clear centers that spread outwards.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Clinical manifestations of chronic gout as background academic context rather than a clinical decision trigger.
The presence of tophi is a key clinical sign indicating that a patient's gout is chronic and has been inadequately controlled. It signals the need for consistent, long-term urate-lowering therapy (ULT).
Nurses play a vital role in assessing for tophi during physical examination and educating patients on the importance of medication adherence (e.g., allopurinol) and lifestyle modifications (diet, alcohol reduction) to manage hyperuricemia and prevent the formation or growth of tophi.
Tophi can ulcerate and discharge a chalky white material (urate crystals), increasing the risk of secondary infection. Nurses must teach patients proper skin care for these areas.

How to Approach the Question

First, identify the key terms in the question: 'Uric acid crystal deposits' and 'gout'. This points to a specific pathological feature of a known disease.
This is a factual recall question that tests your knowledge of the terminology used for the clinical signs of gout.
Review the options and associate each term with its corresponding disease.
Recall that 'tophi' is the specific medical term for the subcutaneous nodules formed by uric acid crystals in chronic gout.
Differentiate this from the other options: Heberden's nodes (osteoarthritis), Erythema nodosum (panniculitis), and Erythema marginatum (rheumatic fever) to confirm the correct answer.

Concept Tested & Keywords

QNJfqpIuUT_sInSDA6OrZL

E6 Medicine Harrison 22e Part 2 pp. 861-863, 862-864

E6 Medicine Davidson Principles Practice 24e p. 1034-1036

Practise the full DSSSB 14 August 2024

Attempt every question from this paper in a timed mock, then review the full solution for each one.