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Acute gout flare — USMLE Step 2 CK MCQ

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HardInternal MedicineAcute gout flareUSMLE Step 2 CK

A 59-year-old with stage 3 chronic kidney disease has had three gout flares in the past year and now has a palpable tophus. The current flare has resolved. Which long-term plan is most appropriate?

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

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Correct answer: B — Start low-dose allopurinol with urate-targeted titration and flare prophylaxis

Explanation lettering: B = shown as A · A = shown as B · E = shown as D · D = shown as E

A is correct: frequent flares and a tophus strongly indicate urate-lowering therapy. Allopurinol remains first line in CKD, but it starts low and is titrated to a serum urate target below 6 mg/dL while colchicine, an NSAID, or glucocorticoid prophylaxis is continued for at least 3–6 months. B uses a nonpreferred initial agent, abandons the urate target, and omits recommended flare prophylaxis. C raises severe toxicity and flare risk. D suppresses inflammation without reducing the urate burden. E is less effective in CKD and abandons treat-to-target monitoring.

Reference: American College of Rheumatology 2020 gout management guideline summary. https://rheumatology.org/press-releases/acr-releases-gout-management-guideline-with-emphasis-on-treat-to-target-strategy-for-urate-lowering-therapy