A client with a sudden onset of big toe joint pain and swelling is diagnosed with gout. Which pathophysiologic process is producing the symptoms of gout?

Deposition of crystals in the synovial space of the joints produces inflammation and irritation.

Chondrocyte injury destroys joint cartilage, producing osteophytes and joint inflammation.

An immune complex and autoantibody deposition in connective tissue results in inflammation.

An autoimmune inflammation involving IgG response to an antigen causes joint destruction.

Answer and Explanation

The Correct Answer is A

Gout is a type of inflammatory arthritis caused by the deposition of monosodium urate crystals in the joints and surrounding tissues. Here's an explanation of the pathophysiological process producing the symptoms of gout:

A) Deposition of crystals in the synovial space of the joints produces inflammation and irritation:

Correct. In gout, elevated levels of uric acid in the blood lead to the formation and deposition of monosodium urate crystals in the synovial fluid of joints, particularly in the big toe joint (first metatarsophalangeal joint) in many cases. These crystals trigger an inflammatory response, activating immune cells and causing swelling, redness, warmth, and severe pain in the affected joint. The inflammation and irritation result from the body's immune response to the presence of these crystals.

B) Chondrocyte injury destroys joint cartilage, producing osteophytes and joint inflammation:

This option describes a process more characteristic of osteoarthritis, where degeneration of joint cartilage leads to the formation of osteophytes (bone spurs) and joint inflammation. Gout involves the deposition of urate crystals rather than direct chondrocyte injury.

C) An immune complex and autoantibody deposition in connective tissue results in inflammation:

This process describes the pathophysiology of autoimmune diseases such as rheumatoid arthritis, where immune complexes and autoantibodies contribute to inflammation and tissue damage. In gout, the inflammation is primarily triggered by the deposition of urate crystals rather than immune complex deposition.

D) An autoimmune inflammation involving IgG response to an antigen causes joint destruction:

This option describes the autoimmune process seen in diseases like rheumatoid arthritis, where antibodies target specific antigens, leading to joint destruction. Gout is not an autoimmune disease, and joint destruction in gout is primarily due to inflammation caused by urate crystal deposition rather than autoimmune mechanisms.

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Correct Answer is D

Explanation

A) The drug may be needed to treat a sudden systemic allergic reaction:

While cortisol may play a role in managing allergic reactions by suppressing inflammation, the primary reason for carrying a cortisol kit in Addison's disease is not typically related to managing allergic reactions.

B) Hypertensive crisis requires immediate treatment to prevent a stroke:

Hypertensive crisis may occur in some individuals with Addison's disease due to adrenal insufficiency, but the immediate treatment for this would typically involve fluids and intravenous hydrocortisone rather than carrying a cortisol kit for self-administration.

C) Hyperglycemia may require cortisol to lower the blood glucose level:

Cortisol can indeed influence blood glucose levels, but the need to carry a cortisol kit is primarily related to the management of adrenal insufficiency rather than hyperglycemia alone.

D) Stress increases the body's need for additional replacement hormone:

Correct. Individuals with Addison's disease have insufficient production of cortisol and often also lack aldosterone. During times of stress, such as illness, trauma, or surgery, the body's demand for cortisol increases to help cope with the stress. Inadequate cortisol production during stress can lead to adrenal crisis, a life-threatening condition. Therefore, carrying a cortisol kit allows the individual to promptly administer additional replacement hormone (usually hydrocortisone) during times of stress to prevent adrenal crisis.

A. Calyx. B. Proximal convoluted tubule. C. Renal pelvis. D. The loop of Henle.

Correct Answer is D

Explanation

The loop of Henle, a critical structure within the nephron of the kidney, plays a key role in the concentration of urine through the process of countercurrent multiplication. Here's why option D is the correct choice:

A) Calyx:

The calyx is a structure in the kidney that collects urine from the renal papillae and channels it into the renal pelvis. It does not directly participate in the concentration of urine.

B) Proximal convoluted tubule:

The proximal convoluted tubule primarily reabsorbs water, electrolytes, and nutrients from the glomerular filtrate, but it does not contribute significantly to the concentration of urine.

C) Renal pelvis:

The renal pelvis is a funnel-shaped structure that collects urine from the calyces and funnels it into the ureter. It is not directly involved in the concentration of urine.

D) The loop of Henle:

Correct. The loop of Henle is the nephron segment responsible for generating a hypertonic medullary interstitium, which creates the osmotic gradient necessary for urine concentration. The loop of Henle achieves this through countercurrent multiplication, where the descending limb allows passive reabsorption of water, while the ascending limb actively pumps out sodium and chloride ions. This creates an osmotic gradient that allows for further water reabsorption in the collecting ducts, leading to concentrated urine.

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A client with a sudden onset of big toe joint pain and swelling is diagnosed with gout. Which pathophysiologic process is producing the symptoms of gout?

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Naxlex Comprehensive Predictor Exams

The nurse is preparing a female client with Addison's disease for self-care afi.4 discharge. Which is the pathophysiological basis to support the need for the client to carry a cortisol kit at all times?

Correct Answer is D

Explanation

In the kidney, where are the mechanisms found that are responsible for increasing urine concentration?

Correct Answer is D

Explanation

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