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Supplements Update on the Diagnosis and Treatment of Gout
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CME/CE Quiz
Understanding Treatments for Gout
Amy C. Cannella, MD; and Ted R. Mikuls, MD, MSPH
Diagnosis of Gout: Clinical, Laboratory, and Radiologic Findings
Naomi Schlesinger, MD
Participating Faculty
Epidemiology of Hyperuricemia and Gout
Andrew J. Luk, MD, MPH; and Peter A. Simkin, MD

CME/CE Quiz

Continuing Medical Education Accreditation
The University of Cincinnati College of Medicine designates this educational activity for a maximum of 2 Category 1 credits toward the AMA Physician's Recognition Award. Each physician should claim only those hours that he/she actually spends in the educational activity.

The University of Cincinnati College of Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to sponsor medical education for physicians.

Continuing Pharmacy Education Accreditation
Pharmacy Times/Ascend Media Office of Continuing Professional Education is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. This program is approved for 2 contact hours (0.2 CEUs) under the ACPE universal program number of 290-999-05-021-H04.

Instructions
After reading "Update on the Diagnosis and Treatment of Gout," complete the program evaluation and select the 1 best answer to each of the following questions. A statement of continuing education hours will be mailed to those who successfully complete (with a minimum score of 70%) the examination at the conclusion of the program.

1. Hyperuricemia is most often the result of:
a) overproduction of urate
b) inefficient excretion of uric acid by the kidneys
c) the tumor lysis syndrome
d) high cellular turnover

2. Gout is more prevalent among:
a) men than women
b) European Americans than African Americans
c) premenopausal than postmenopausal women
d) persons < 65 years of age than those > 65 years of age

3. The metabolic syndrome is present in up to what percentage of gout patients?
a) 25%
b) 55%
c) 76%
d) 92%

4. Increased risk of gout is associated with:
a) lipid-lowering therapy
b) diuretic use
c) nonsteroidal anti-inflammatory drug (NSAID) use
d) insulin therapy

5. The risk of gout is greater for those with diets high in:
a) red meat and seafood
b) purine-rich vegetables
c) wine
d) low-fat dairy products

6. All of the following may be reasons for the increasing prevalence of gout in the United States except:
a) increasing longevity
b) increased use of diuretics
c) increased use of hormone replacement therapy
d) increased prevalence of end-stage renal disease

7. The gold standard for a gout diagnosis is:
a) demonstration of hyperuricemia
b) radiographic evidence
c) presence of monosodium urate crystals in joint fluid or tophus
d) response to colchicine

8. A gouty arthritis attack is most notably characterized by:
a) rapid onset and buildup of pain
b) pain and swelling developing over time
c) pain without swelling
d) warmth or redness of the affected joint

9. Gouty arthritis in the elderly is often mistaken for:
a) rheumatoid arthritis
b) psoriatic arthritis
c) osteoarthritis
d) Heberden's nodes

10. In women:
a) Acute podagra is usually the first manifestation of gout.
b) Arthritis in multiple joints is often the first manifestation of gout.
c) Hormone replacement therapy may exacerbate gout.
d) Gouty arthritis tends to be more symmetric than rheumatoid arthritis.

11. Pseudogout can be differentiated from gout with:
a) radiographic studies
b) location of the affected joint
c) previous confirmed gout diagnosis
d) identification of calcium pyrophosphate dihydrate crystals

12. Dietary restrictions with weight loss and decreased triglycerides benefit gout patients through:
a) improved insulin sensitivity
b) reduced plasma insulin
c) increased renal urate excretion
d) all of the above

13. Which is the treatment of choice for an acute gouty arthritis attack?
a) NSAIDs
b) oral corticosteroids
c) colchicine
d) urate-lowering agents

14. The goal of antihyperuricemic therapy in recurrent gout is to lower serum urate concentration to what level?
a) 8-9 mg/dL
b) 7-8 mg/dL
c) 6-7 mg/dL
d) 5-6 mg/dL

15. Which is usually the urate-lowering agent of choice?
a) probenacid
b) sulfinpyrazone
c) allopurinol
d) losartan

16. In a patient with gout and hyperlipidemia, __________ may be a useful adjunctive urate-lowering agent.
a) fenofibrate
b) estrogen
c) low-dose aspirin
d) a thiazide diuretic

17. Which of the following statements about the uricosuric agents probenecid and sulfinpyrazone is true?
a) They reduce uric acid excretion.
b) They should be started in low doses.
c) They should be administered with low-dose aspirin.
d) They are indicated for patients with hyperuricemia resulting from overproduction of uric acid.

18. Urate-lowering treatment is cost effective for patients with at least how many gouty flares per year?
a) 1
b) 2
c) 3
d) 4

19. Poor social functioning is greater among those with:
a) hypertension
b) angina
c) diabetes
d) gout

20. Gout outcomes can be improved with:
a) specialist treatment
b) medication compliance
c) earlier diagnosis and treatment
d) all of the above

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