09-03-2008, 02:37 PM
_ A 57-year-old man comes to the emergency department because of excruciating pain in his right big toe. He describes the pain as so severe that it woke him from a deep sleep. He has no chronic medical conditions, does not take any medications, and denies any similar episodes in the past. He admits to a few "drinking binges" over
the past 2 weeks. His temperature is 38.1 C (100.5 F), blood pressure is 130/90 mm Hg, and pulse is 80/min. Examination shows an erythematous, warm, swollen, and exquisitely tender right great toe. The skin overlying the first metatarsophalangeal joint is dark red, tense, and shiny. Synovial fluid analysis reveals negatively birefringent, needle-shaped crystals within polymorphonuclear leukocytes (PMNs). Laboratory studies show:
Serum
Leukocytes........16,000/mm3
Uric acid...........15 mg/dL
Calcium.............9 mg/dL
Which of the following is the most appropriate pharmacotherapy?
A. Allopurinol
B. Ceftriaxone
C. Indomethacin
D. Probenecid
E. Sulfinpyrazone
the past 2 weeks. His temperature is 38.1 C (100.5 F), blood pressure is 130/90 mm Hg, and pulse is 80/min. Examination shows an erythematous, warm, swollen, and exquisitely tender right great toe. The skin overlying the first metatarsophalangeal joint is dark red, tense, and shiny. Synovial fluid analysis reveals negatively birefringent, needle-shaped crystals within polymorphonuclear leukocytes (PMNs). Laboratory studies show:
Serum
Leukocytes........16,000/mm3
Uric acid...........15 mg/dL
Calcium.............9 mg/dL
Which of the following is the most appropriate pharmacotherapy?
A. Allopurinol
B. Ceftriaxone
C. Indomethacin
D. Probenecid
E. Sulfinpyrazone