MRCP Q 180

A 79-year-old woman who drinks 30 units of alcohol per week presents with a red, hot swollen ankle. Which investigation yield a definitive diagnosis?

1. Blood culture
2. Joint aspiration and microscopy
3. Joint aspiration and culture
4. X-ray of the ankle
5. Serum uric acid levels

Correct Answer 2

Joint aspiration and microscopy This patient most probably has acute gouty arthritis that be precipitated by her high alcohol intake. Joint aspiration and microscopy show the characteristic long needleshaped crystals (uric acid crystals) that are negatively birefringent under polarised light. Serum uric acid levels actually be low in cases of acute gout. Septic arthritis is rare in the absence of any systemic infection or injury to the joint.

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