Your Name: Mubarik Arshad

Theme: Causes of Gout

OPTION LIST

A	Diet	I	Leukaemia
B	Ethanol	J	Low dose aspirin
C	Glucose 6 phosphatase deficiency	K	Renal Failure
D	High dose aspirin	L	Thiazide diuretics
E	Hyperlipidaemia	M
F	Idiopathic	N
G	Lactic acid accumulation	O
H	Lesch-Nyhan Syndrome	P

For each scenario below, choose the most appropriate underlying diagnosis from the list above. Each option may be used once, more than once or not at all.

1. A 49 year old man complains of recent severe pain in his left first toe, both knees and ankles. This occurred after a heavy Friday night out. On examination there was marked swelling and redness of the toe. The pain was especially evident if touched.

2. A 55 year old man complains of swelling of his legs, pain in his ankles and left big toe and tiredness. On examination, there is oedema of his legs, swelling and redness on his ankles and left MTP joint. He has gross proteinurea and the serum albumin is 30 g/L.

3. A 48 year old gentleman develops a painful right big toe two days after being admitted into hospital with a BP of 180/120.

4. A 58-year old man presents with lethargy and generalised weakness. He has a 2 year history of upper abdominal pain especially after meals and suffered a myocardial infarct 3 years ago. Recently he has noticed swelling in his right first toe. Examination reveals tenderness in the epigastrium. No masses are felt and there is no organomegaly. Endoscopy reveals an active duodenal ulcer.

5. An 8 year old boy, showing signs of slow development, presents with a painful right knee which on examination was hot and swollen. Scratch marks on his face were also observed. An aspiration of the synovial fluid from the joint revealed crystals which were negatively birefringent.

ANSWERS

1. B

2. K

3. L

4. J

5. H