QuestionSBA
QuestionChoice
This is a classic history of an acute gout attack: the patient has a painful big toe as well as risk factors for gout including being an older overweight male with a history of hypertension and CKD. The investigation findings also point towards a diagnosis of gout. Methotrexate is a disease-modifying anti-rheumatic drug (DMARD), and it is used in the management of rheumatoid arthritis. It has no role in the management of acute gout.
10003720
e
Methotrexate
QuestionChoice
This is a classic history of an acute gout attack: the patient has a painful big toe as well as risk factors for gout including being an older overweight male with a history of hypertension and CKD. The investigation findings also point towards a diagnosis of gout. Allopurinol should be commenced at a low dose at least 2 weeks following an attack of gout; it is not used in the acute setting.
10003718
c
Allopurinol
QuestionChoice
This is a classic history of an acute gout attack: the patient has a painful big toe as well as risk factors for gout including being an older overweight male with a history of hypertension and CKD. The investigation findings also point towards a diagnosis of gout. The NSAID indomethacin is traditionally used first-line, but because this patient has CKD, NSAIDs should be avoided. Hence, colchicine is the most appropriate therapy.
10003716
a
Colchicine
QuestionChoice
This is a classic history of an acute gout attack: the patient has a painful big toe as well as risk factors for gout including being an older overweight male with a history of hypertension and CKD. The investigation findings also point towards a diagnosis of gout. The NSAID indomethacin is traditionally used first-line, but because this patient has CKD, NSAIDs should be avoided.
10003717
b
Indomethacin
QuestionChoice
This is a classic history of an acute gout attack: the patient has a painful big toe as well as risk factors for gout including being an older overweight male with a history of hypertension and CKD. The investigation findings also point towards a diagnosis of gout. Febuxostat is used if allopurinol fails or is contraindicated in the prophylactic management of gout. It is not used in the management of acute gout.
10003719
d
Febuxostat
Concept
Chapter
2693
3768
Gout
Topic
146
Rheumatology
13290
A 61-year-old overweight man presents to A&E with severe pain at the base of his right big toe which has been present for 2 days. He says that nothing makes it better, and even slight pressure makes it worse. He has a past medical history of hypertension and chronic kidney disease.

On examination, his right big toe is erythematous and swollen.

Arthrocentesis with synovial fluid analysis shows needle-shaped monosodium urate crystals with negative birefringence.

What is the most appropriate management for this man?
a