QuestionSBA
QuestionChoice
Septic arthritis can present very similarly to this case with acute, severe pain developing over hours.

Patients may have a history of a urinary tract infection or a respiratory tract infection. The bacteria may have spread to the knee leading to septic arthritis. it can also be caused by direct innoculation by a penetrating injury for example an animal bite.

Aspiration would be negative for crystals with a high white blood cell and neutrophil count with a positive gram stain for bacteria.
10005982
b
Infection
QuestionChoice
Pseudogout is caused by the deposition of a calcium-based crystal in the joint. These are called calcium pyrophosphate dihydrate crystals that appear positively bifringent and rhomboid shape on crystal microscopy.

The presentation would be similar and the aspiration allows you to differentiate the conditions.
10005983
c
Hypercalcaemia
QuestionChoice
Aspiration of the joint along with the clinical picture supports the diagnosis of gout rather than an autoimmune pathogenesis.

With rheumatoid arthritis, it is usually a slower onset > 6 weeks with multiple joint involvements on both sides of the body.
10005985
e
Autoimmunity
QuestionChoice
alcohol can increase uric acid in the bloodstream which increases risk of gout and increase the frequency and severity of attacks.

Uric acid is the direct cause of gout as this is what deposits into the joint.
10005984
d
Alcohol
QuestionChoice
Gout is caused by a build up of uric acid in the blood. This deposits in the joint as needle shaped crystals. There is an increased risk with a high purine diet, family history, renal impairment and therefore reduced clearance of uric acid.

Gout attacks are acute and severe in nature and usually develop over several hours.
10005981
a
Hyperuricaemia
Concept
Chapter
2693
4463
Gout
Topic
162
General practice
13743
65 year old male presents to accident and emergency with a very hot, swollen and extremely tender big toe that has developed over 2 hours.

Aspiration of the joint is undertaken and crystal microscopy shows negatively bifringent needles.

What is the direct cause of this condition?
a