#january2020mccqe1
A 52-year-old man presented four days ago when a diagnosis was made of typical acute gout in his left great toe metatarsophalangeal joint as shown in the image. He has no past history of joint problems. He has responded to indomethacin 50mg t.d.s. and his serum uric acid taken at the time of presentation was 0.56mmol/L (0.14-0.42). Which one of the following is the most appropriate next step in treatment?
(A) Cease indomethacin and prescribe allopurinol 300mg daily
(B) Aspirate the joint to confirm the diagnosis
(C) Continue his indomethacin for three months
(D) X-ray his foot to exclude other joint pathology
(E) Reduce his medication over one week and review
A 52-year-old man presented four days ago when a diagnosis was made of typical acute gout in his left great toe metatarsophalangeal joint as shown in the image. He has no past history of joint problems. He has responded to indomethacin 50mg t.d.s. and his serum uric acid taken at the time of presentation was 0.56mmol/L (0.14-0.42). Which one of the following is the most appropriate next step in treatment?
(A) Cease indomethacin and prescribe allopurinol 300mg daily
(B) Aspirate the joint to confirm the diagnosis
(C) Continue his indomethacin for three months
(D) X-ray his foot to exclude other joint pathology
(E) Reduce his medication over one week and review
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