Gout: choice of urate-lowering drug: practice question

A Biochemistry 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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Biochemistry · Gout: choice of urate-lowering drug

Sample item

A 52-year-old man with tophaceous gout has had a uric acid renal stone. A 24-hour urine collection shows 1100 mg of uric acid, on a regular diet. Which long-term drug is best?

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

The answer and the reasoning

C. Allopurinol

A 24-hour urinary uric acid above about 800 mg indicates overproduction, and the stone history favours reducing urate formation. Allopurinol, and its metabolite oxypurinol, inhibits xanthine oxidase and lowers both serum and urinary uric acid. Uricosuric drugs such as probenecid raise urinary uric acid and may precipitate stones.

Option by option

  • A. Colchicine alone

    Colchicine reduces inflammation and flares, but does not lower uric acid.

  • B. Probenecid

    Probenecid blocks tubular urate reabsorption by URAT1, increasing urinary uric acid and stone risk.

  • C. Allopurinol (correct)

    Correct. A xanthine oxidase inhibitor lowers production and urinary urate.

  • D. Indomethacin

    Indomethacin treats acute attacks and does not lower uric acid.

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 Biochemistry question

What is the answer to this Biochemistry question?

The best answer is C, Allopurinol. A 24-hour urinary uric acid above about 800 mg indicates overproduction, and the stone history favours reducing urate formation.

Why is "Colchicine alone" not the answer?

Colchicine reduces inflammation and flares, but does not lower uric acid.

Why is "Probenecid" not the answer?

Probenecid blocks tubular urate reabsorption by URAT1, increasing urinary uric acid and stone risk.

Why is "Indomethacin" not the answer?

Indomethacin treats acute attacks and does not lower uric acid.

What concept does this question test?

It tests Gout: choice of urate-lowering drug in Biochemistry. Allopurinol, and its metabolite oxypurinol, inhibits xanthine oxidase and lowers both serum and urinary uric acid. Uricosuric drugs such as probenecid raise urinary uric acid and may precipitate stones.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Gout: choice of urate-lowering drug?

Build one table of enzyme deficiency, disease, inheritance and key finding, then revise it by spaced recall. Then use the flashcards and the other Biochemistry 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.