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Gout — SCE Rheumatology MCQ

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ModerateCrystal ArthropathiesGoutSCE Rheumatology

A 42-year-old woman has abrupt overnight first MTP pain, erythema, CKD, thiazide use and needle-shaped negatively birefringent crystals in synovial fluid. What is the most appropriate investigation?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Joint aspiration for crystal analysis and culture

Joint aspiration for crystal analysis and culture is the single best answer because monosodium urate crystals confirm gout. The stem is testing investigation selection, not isolated recall, so the relevant clinical pattern and risk context determine the answer. Septic arthritis is less suitable because it fits a different clinical pattern or a different treatment threshold; Reactive arthritis, Serum urate alone and Allopurinol during severe drug rash do not address the key discriminator in this vignette. Clinical pearl: in SCE-style rheumatology questions, autoantibodies, imaging and synovial fluid findings should be interpreted with the whole phenotype.

Reference: NICE NG219; BSR gout and hot swollen joint guidance; BNF