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FMGE 2017 — Internal Medicine

Q: Which of the following is the best investigation for acute gout?

Uric acid in synovial fluid. ***Uric acid in synovial fluid*** - The definitive diagnosis of acute gout is established by identifying **negatively birefringent needle-shaped uric acid crystals** within the synovial fluid of the affected joint [1]. - This method directly confirms the presence of **monosodium urate crystals**, which are the hallmark of gout, offering diagnostic certainty [1]. *Uric acid in urine* - While urinary uric acid levels can help assess uric acid excretion, they are not diagnostic for acute gout and do not directly show the presence of **intra-articular crystals**. - This test is more relevant for investigating the **cause of hyperuricemia** (overproduction vs. underexcretion) rather than diagnosing an acute flare. *Anti CCP antibodies* - **Anti-cyclic citrullinated peptide (anti-CCP) antibodies** are markers for **rheumatoid arthritis** and are not relevant for the diagnosis of acute gout. - Their presence indicates an autoimmune inflammatory condition distinct from crystal-induced arthropathy. *Serum uric acid* - Serum uric acid levels are often elevated during an acute gout flare (**hyperuricemia**), but this is not diagnostic, as many individuals with hyperuricemia never develop gout [1]. - Approximately 30% of patients may have **normal serum uric acid levels** during an acute attack, making it an unreliable sole diagnostic criterion.

11 Questions — Page 2 of 2

All Subjects Anatomy (10)Biochemistry (4)Community Medicine (1)Dental (1)Internal Medicine (11)Microbiology (4)Obstetrics and Gynecology (3)Ophthalmology (2)Orthopaedics (3)Pathology (8)Pediatrics (2)Pharmacology (15)Physiology (5)Psychiatry (6)Radiology (1)Surgery (2)

Q11

Which of the following is the best investigation for acute gout?