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File:IPLab5Gout8.jpg|This is a gross photograph of a tophus on the great toe of another patient with gout (arrow). The healed surgical incision and the size of this tophus indicate that this was a long-standing problem for this patient.
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== Study Questions ==
* <spoiler text="What are the two types of gout and which is more common?">The main type is primary gout which makes up 90% of all cases. In most cases of primary gout the enzyme defect is unknown. In rare cases the enzyme defect is known, but gout symptomatology is the main clinical finding.
In secondary gout the cause of the hyperuricemia is known (e.g. leukemia, renal failure, Lesch-Nyhan syndrome).</spoiler>
* <spoiler text="What are the four stages of gout?"># Asymptomatic hyperuricemia
# Acute gouty arthritis
# Intercritical gout
# Chronic tophaceous gout.</spoiler>
* <spoiler text="Why is gout more severe in peripheral joints?">The decreased temperature accentuates the crystallization of monosodium urate (MSU).</spoiler>
* <spoiler text="What initiates the inflammatory reaction seen in the synovial membrane in gouty arthritis?">MSU crystals are chemotactic and they activate complement. This initiates a cascade of inflammatory events which leads to acute gouty arthritis.</spoiler>
{{IPLab 5}}
[[Category: IPLab:Lab 5]]