AANP Family Nurse Practitioner (FNP) Certification ExamDiagnosisEasy
A 40-year-old male presents with acute onset of severe, excruciating pain and swelling in his left great toe. He denies trauma. He reports a history of frequent alcohol consumption and recently started a new diuretic medication for hypertension. On examination, the affected joint is red, hot, swollen, and exquisitely tender to touch. His serum uric acid level is 9.0 mg/dL (normal <7.0 mg/dL). What is the most likely diagnosis?
- AGout
- BCellulitis
- CSeptic Arthritis
- DPseudogout
Show answer & explanationAnswer & explanation
Correct answer: A. Gout
The patient's acute onset of severe pain, redness, swelling, and tenderness in the great toe (podagra), along with a history of alcohol use, diuretic use, and elevated serum uric acid, are classic indicators of an acute gouty arthritis attack.
Why the other options are wrong
- B. Cellulitis would present with erythema, warmth, and swelling, but typically lacks the exquisite tenderness and systemic risk factors for crystal arthropathy.
- C. Septic arthritis is a possibility with acute monoarticular arthritis, but fever and systemic signs of infection would be more prominent, and the strong link to hyperuricemia and triggers makes gout more likely initially.
- D. Pseudogout (calcium pyrophosphate deposition disease) also causes acute arthritis, but typically affects larger joints (e.g., knee, wrist) and is associated with calcium pyrophosphate crystals, not hyperuricemia.
Gout
A form of inflammatory arthritis characterized by sudden, severe attacks of pain, redness, and tenderness in joints, caused by the deposition of uric acid crystals.
- Often affects the great toe (podagra), but can involve other joints.
- Triggered by hyperuricemia, alcohol consumption, certain foods, and diuretics.
- Diagnosis confirmed by finding urate crystals in synovial fluid.
Memory trick: GOUT: Great toe, Overconsumption (alcohol), Uric acid high, Tender/red.