USMLE Step 1 Question 327

Question:

A 45-year-old male patient presents with excruciating pain in his right large toe. The pain woke him from sleep last night and continued throbbing throughout the night. The toe on examination is warm and tender. No other joints are affected. Patient admits to 3-4 alcoholic drinks per night and diet consisting mainly of steak and potatoes. What drug will be the best choice to treat this acute attack?

Correct Answer: C.  Indomethacin

The patient is suffering from gout. Gout often manifests in patients with a diet high in alcohol and red meat (high in purines). Most often the large toe is affected (podagra). Most commonly, the first line of treatment is a high dose of an NSAID such as indomethacin (option C). Gout is a inflammatory reaction to urate crystals in the joint and acetaminophen (option A) and morphine (option D) do not have anti-inflammatory properties.

Allopurinol (A) and probenecid (E) are drugs used to treat chronic gout but are not useful in the acute setting since they might worsen the attack. They work as prophylaxis by decreasing uric acid levels.