AANP Family Nurse Practitioner (FNP) Certification ExamDiagnosisMedium
A 40-year-old male presents with acute onset of excruciating pain and swelling in his left great toe. He denies trauma. On examination, the joint is red, hot, and exquisitely tender to touch. He reports a history of occasional similar episodes in the past, often after consuming alcohol or red meat. His serum uric acid level is 8.5 mg/dL (normal range 3.5-7.2 mg/dL). What is the most likely diagnosis?
- ACellulitis
- BPseudogout
- CGout
- DSeptic arthritis
Show answer & explanationAnswer & explanation
Correct answer: C. Gout
The patient's acute onset of severe pain, redness, swelling, and exquisite tenderness in the MTP joint of the great toe (podagra), combined with a history of similar episodes associated with alcohol/red meat, and elevated serum uric acid, are classic for an acute gouty arthritis flare.
Why the other options are wrong
- A. Cellulitis typically presents with poorly demarcated erythema, warmth, and tenderness, but often lacks the exquisite joint tenderness and history of recurrent podagra, and is not directly linked to hyperuricemia.
- B. Pseudogout (calcium pyrophosphate deposition disease) also causes acute monoarticular arthritis, but typically affects larger joints (knee, wrist), occurs in older individuals, and is associated with calcium pyrophosphate crystals, not uric acid crystals or hyperuricemia.
- D. Septic arthritis would present with acute joint pain, redness, and swelling, but usually with fever and systemic signs of infection, and would not have a history of diet-related flares or hyperuricemia as a direct cause.
Gout
A form of inflammatory arthritis characterized by recurrent attacks of acute inflammatory arthritis (red, tender, hot, swollen joint) caused by deposition of uric acid crystals in the joints.
- Acute onset, severe pain, redness, swelling, exquisite tenderness (often in great toe - podagra).
- Triggered by alcohol, purine-rich foods (red meat, seafood), dehydration.
- Diagnosis: elevated serum uric acid and/or identification of needle-shaped, negatively birefringent urate crystals in synovial fluid.
Memory trick: Gout is a 'Great' toe 'Attack' from too much 'Uric Acid'.