An older male reports to the clinic nurse that he sometimes feels chest pressure and becomes breathless. He further describes an event where he had to sit for about one hour before he felt better. He is asymptomatic at rest, but is concerned that he has had a heart attack. This clinical picture is consistent with which cardiac ischemic event?

Gout is a form of inflammatory arthritis characterized by sudden, severe attacks of pain, redness, and swelling in the joints, commonly affecting the big toe joint (first metatarsophalangeal joint). The primary pathophysiological process underlying gout involves the deposition of monosodium urate crystals in the joints and surrounding tissues. Here's an explanation of why option A is the correct answer:

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

Correct. Elevated levels of uric acid in the blood can lead to the formation of monosodium urate crystals, which then accumulate in the synovial fluid of joints, particularly in the big toe 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 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 inflammation and the formation of osteophytes (bone spurs). Gout does not directly involve 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.

The client's symptoms, along with the elevated serum amylase and lipase levels, suggest the development of acute pancreatitis as a postoperative complication. Here's a detailed explanation for why option A is the correct choice:

A) Acute pancreatitis:

Correct. Acute pancreatitis is characterized by inflammation of the pancreas, which can be triggered by various factors, including gallstones, alcohol consumption, and certain medications. In this case, the client's recent cholecystectomy for cholelithiasis (gallstones) may have led to the development of acute pancreatitis. The persistent upper abdominal pain radiating to the back, along with vomiting and fever, are classic symptoms of acute pancreatitis. Elevated serum amylase and lipase levels are common laboratory findings in acute pancreatitis due to pancreatic cell injury and leakage of these enzymes into the bloodstream.

B) Surgical site infection:

While surgical site infections are potential complications of cholecystectomy, the client's symptoms, including upper abdominal pain, vomiting, and fever, are more indicative of a systemic inflammatory process rather than localized infection at the surgical site.

C) Hepatorenal failure:

Hepatorenal failure, also known as hepatorenal syndrome, refers to kidney dysfunction that occurs as a complication of advanced liver disease. The client's symptoms and laboratory findings are not consistent with hepatorenal failure, as there are no signs of significant liver dysfunction or advanced liver disease.

D) Biliary duct obstruction:

While biliary duct obstruction can lead to symptoms similar to those of acute pancreatitis, such as upper abdominal pain and vomiting, the presence of elevated serum amylase and lipase levels strongly suggests pancreatic involvement rather than isolated biliary duct obstruction.