WBR0751

Author	[[PageAuthor::Yazan Daaboul, M.D. (Reviewed by Yazan Daaboul, M.D.)]]
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Pathophysiology
Sub Category	SubCategory::Musculoskeletal/Rheumatology
Prompt	[[Prompt::A 58-year-old man presents to the emergency department with complaints of excruciating right toe pain. Physical examination is remarkable for erythema, edema, and tenderness around the right metatarsophalangeal joint (MTPJ) of the great toe. In contrast, the left lower extremity appears normal. Lab work-up reveals elevated blood concentration of uric acid. Arthrocentesis of the joint is performed, and fluid analysis demonstrates needle-shaped yellow crystals under parallel light. Which of the following findings during history-taking is most consistent with this patient's diagnosis?]]
Answer A	AnswerA::Recent intake of beer
Answer A Explanation	AnswerAExp::Intake of beer and other alcohols is associated with the development of gouty attacks.
Answer B	AnswerB::Personal history of appendicitis
Answer B Explanation	AnswerBExp::Appendicitis is not associated with development of gout.
Answer C	AnswerC::Chronic exposure to paint
Answer C Explanation	AnswerCExp::Chronic exposure to paint is not associated with the development of gout.
Answer D	AnswerD::Recent strenuous exercise
Answer D Explanation	AnswerDExp::Exercise may help with decreasing the number of episodes of gouty attacks.
Answer E	AnswerE::Recent intake of corticosteroids
Answer E Explanation	AnswerEExp::Corticosteroids may be used to relieve symptoms of gout.
Right Answer	RightAnswer::A
Explanation	[[Explanation::Gout is the most common inflammatory arthritis in men. It is characterized by the deposition of monosodium urate (MSU) crystals and is associated with hyperuricemia (overproduction of urate or underexcretion of urate by the kidneys). Blood concentration of uric acid is typically higher than 6.8 mg/dL in gout. Beyond this concentration, uric acid is not soluble anymore in physiologic condition. Gout has 2 phases: The first phase is characterized by episodic attacks, each lasting 1-2 weeks. The second phase occurs secondary to an untreated initial phase, whereby patients progress to chronic tophaceous gout with polyarticular attacks. While patients remain asymptomatic between attacks in the first phase, they are symptomatic between attacks in the second phase. Alcohol may induce hyperuricemia, and hyperuricemia has often been used as a marker of alcohol intake. Among alcohol beverages, beer is the most strongly associated with recurrence of gouty attacks; probably due to its high content of guanosine, which is a highly absorbable purine when compared with other nucleosides. Intake of two or more beers per day is associated with a two-fold increased risk of development of gout. Educational Objective: Gout is characterized by the deposition of monosodium urate (MSU) crystals and is associated with hyperuricemia (overproduction of urate or underexcretion of urate by the kidneys). Beer intake is associated with the development of gout. References: Choi HK, Atkinson K, Karlson EW. et al. Alcohol intake and risk of incident gout in men: a prospective study. The Lancet. 2004;363:1277-81. Neogi T. Gout. N Engl J Med. 2011; 364:443-452. First Aid 2014 page 425]]
Approved	Approved::No
Keyword	WBRKeyword::Beer, WBRKeyword::Alcohol, WBRKeyword::Intake, WBRKeyword::Gout, WBRKeyword::Gouty attack, WBRKeyword::Hyperuricemia, WBRKeyword::Uric acid, WBRKeyword::Inflammatory arthritis, WBRKeyword::Monosodium urate, WBRKeyword::MSU
Linked Question	Linked::
Order in Linked Questions	LinkedOrder::