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Gout — SCE Rheumatology MCQ

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EasyCrystal arthropathiesGoutSCE Rheumatology

A 29-year-old woman develops abrupt nocturnal first MTP pain and swelling. Examination shows the joint is hot, erythematous and exquisitely tender. Investigations show synovial fluid shows needle-shaped negatively birefringent crystals. The admitting team asks which diagnosis best explains the whole presentation. What is the most likely diagnosis?

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Correct answer: B — Gout

Gout is the best answer because the pattern described is most consistent with Gout, including the distribution of symptoms and the targeted investigation results. Acute CPP crystal arthritis is a plausible distractor, but it does not account for the key discriminator in the stem. Osteoarthritis flare and Psoriatic arthritis would be more appropriate in a different clinical pattern or at another point in the pathway, while Hydroxychloroquine retinopathy is suboptimal for this presentation. Clinical pearl: in SCE-style questions, the decisive clue is usually the pattern across joints, extra-articular features and targeted immunology rather than a single antibody result.

Reference: NICE NG219; BSR hot swollen joint guideline; EULAR crystal arthropathy recommendations