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Gout flare — ABEM Board MCQ

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EasyMusculoskeletal/Orthopedic emergenciesGout flareABEM Board

A 62-year-old man arrives with severe first metatarsophalangeal joint pain that woke him from sleep. Triage acuity is ESI 4; T 99.4 F, BP 146/84 mm Hg, HR 88/min. The joint is red, swollen, and exquisitely tender. He recently started hydrochlorothiazide. Which of the following is the most likely diagnosis?

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

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Correct answer: A — Acute gout flare

Podagra with abrupt nocturnal onset and thiazide exposure is typical of acute gout, though infection should be considered if systemic features are present.

Reference: ACR gout guideline