Rheumatology: choice of urate-lowering drug in overproducers: 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.

Try it

General Medicine · Rheumatology: choice of urate-lowering drug in overproducers

Sample item

A 45-year-old man with recurrent tophaceous gout has had two uric acid renal stones. A 24-hour urine collection shows very high uric acid excretion. Which urate-lowering drug is the most appropriate?

ASulfinpyrazoneBProbenecidCBenzbromaroneDAllopurinol

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

The answer and the reasoning

D. Allopurinol

Overproducers with uric acid stones need a drug that reduces uric acid synthesis. Allopurinol inhibits xanthine oxidase. Uricosurics raise urinary uric acid further and increase the risk of stones.

Option by option

A. Sulfinpyrazone
Sulfinpyrazone is also uricosuric and would raise urinary uric acid excretion.
B. Probenecid
Probenecid increases urinary uric acid and would promote more stones.
C. Benzbromarone
Benzbromarone is a uricosuric agent and is unsuitable in a stone former.
D. Allopurinol (correct)
Correct. A xanthine oxidase inhibitor lowers production and urinary uric acid load.

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.

Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Allopurinol. Overproducers with uric acid stones need a drug that reduces uric acid synthesis.

Why is "Sulfinpyrazone" not the answer?

Sulfinpyrazone is also uricosuric and would raise urinary uric acid excretion.

Why is "Probenecid" not the answer?

Probenecid increases urinary uric acid and would promote more stones.

Why is "Benzbromarone" not the answer?

Benzbromarone is a uricosuric agent and is unsuitable in a stone former.

What concept does this question test?

It tests Rheumatology: choice of urate-lowering drug in overproducers in General Medicine. Allopurinol inhibits xanthine oxidase. Uricosurics raise urinary uric acid further and increase the risk of stones.

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: choice of urate-lowering drug in overproducers?

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.