Rheumatology: gout: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Rheumatology: gout

Sample item

A 50-year-old man has sudden severe pain, redness and swelling of the first metatarsophalangeal joint. Joint fluid shows needle-shaped, negatively birefringent crystals. Which drug is appropriate for the acute attack and which is started later for prevention?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. An NSAID or colchicine for the attack, with allopurinol for long-term urate lowering

Acute gouty arthritis is treated with NSAIDs, colchicine or corticosteroids. Urate-lowering therapy (allopurinol or febuxostat) is started once the attack settles, usually with prophylactic colchicine or NSAID for the first months, and titrated to a serum urate below 6 mg/dL. Starting or changing urate-lowering drugs without cover can provoke attacks.

Option by option

  • A. Allopurinol started at full dose during the attack, with no anti-inflammatory

    Urate-lowering drugs alone do not treat the inflammation and can prolong the attack if started without cover.

  • B. Aspirin in low dose to lower uric acid

    Low-dose aspirin slightly raises serum urate and is not a treatment for gout.

  • C. Probenecid alone for the attack

    Probenecid lowers urate and does not relieve an acute attack.

  • D. An NSAID or colchicine for the attack, with allopurinol for long-term urate lowering (correct)

    Correct. Anti-inflammatory treatment for the attack and urate-lowering therapy for prevention.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, An NSAID or colchicine for the attack, with allopurinol for long-term urate lowering. Acute gouty arthritis is treated with NSAIDs, colchicine or corticosteroids.

Why is "Allopurinol started at full dose during the attack, with no anti-infl…" not the answer?

Urate-lowering drugs alone do not treat the inflammation and can prolong the attack if started without cover.

Why is "Aspirin in low dose to lower uric acid" not the answer?

Low-dose aspirin slightly raises serum urate and is not a treatment for gout.

Why is "Probenecid alone for the attack" not the answer?

Probenecid lowers urate and does not relieve an acute attack.

What concept does this question test?

It tests Rheumatology: gout in General Medicine. Urate-lowering therapy (allopurinol or febuxostat) is started once the attack settles, usually with prophylactic colchicine or NSAID for the first months, and titrated to a serum urate below 6 mg/dL. Starting or changing urate-lowering drugs without cover can provoke attacks.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Rheumatology: gout?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.