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Review of Clinical Signs Review Questions

Clinical Signs of Gout

Prashanth Sunkureddi, MD, Tracy U. Nguyen-Oghalia, MD,
and Bernard M. Karnath, MD

All questions are based on the patient in question #1.

1. An obese 65-year-old man who was admitted to the hospital for unstable angina suddenly develops pain and swelling in his left knee. On the previous day, he underwent a heart catheterization, which was uneventful. Physical examination reveals an erythematous and swollen left knee with exquisite tenderness to touch. Laboratory tests show a serum creatinine level of 1.6 mg/dL (normal, 0.6-1.3 mg/dL). His past medical history is significant for hypertension, diabetes, and hyperlipidemia. His current medications include aspirin 325 mg daily; amlodipine, 10 mg daily; enalapril 10 mg daily; hydrochlorothiazide, 25 mg daily; and glipizide, 5 mg daily. What would be the most useful test to evaluate this patient at this time?

  1. Bone scan
  2. Joint aspiration
  3. Nonalcoholic steatohepatitis
  4. Magnetic resonance imaging (MRI)
  5. Plain radiography of the knee
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2. Synovial fluid aspiration from the left knee of the patient revealed a mildly cloudy and viscous fluid with a negative Gram stain, leukocyte count of 50 × 103µL with a predominance of neutrophils, and bright yellow, negatively birefringent crystals, some engulfed by leukocytes. What is this patient’s diagnosis?

  1. Gout
  2. Hemarthrosis
  3. Liver biopsy
  4. Pseudogout
  5. Septic arthritis
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3. What is the most appropriate treatment for this patient?
  1. Allopurinol
  2. Colchicine
  3. Indomethacin
  4. Intra-articular corticosteroids
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4. After injection of 40 mg of triamcinolone plus lidocaine into his left knee, the patient feels substantially better the next day and the swelling has improved as well. Results of laboratory tests reveal a serum uric acid level of 9.8 mg/dL (normal, 5.07.0 mg/dL). Which of the following is NOT a contributory factor to this patient’s hyperuricemia?

  1. Aspirin 325 mg
  2. Hydrochlorothiazide
  3. Obesity
  4. Renal insufficiency
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5. What is the next step in the management of this patient’s hyperuricemia?

  1. Start allopurinol 300 mg daily
  2. Start prophylactic colchicine 0.6 mg daily
  3. Educate patient about the disease and have him follow-up in clinic in a few weeks
  4. Start probenecid 500 mg daily
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