Step 1: View clinicals

A 45 year old man presents with excruciating pain, redness and swelling of his right big toe. There is no history of trauma. His medical history is unremarkable, and he is not on any drugs. He smokes 1 to 2 cigarettes each day and drinks around 10 to 12 units of alcohol each week.

Step 2: Order all relevant investigations

Full Blood Count

WBC: 16,000/mm3 (4,000-11,000) Hb: 13.4 mg/dl Platelets: 256,000/mm3 (150,000-400,000)

Uric Acid

Serum Uric Acid: 7.4 mg/dl (<6.8 mg/dl)

Joint Fluid Aspiration

Appearance: clear WBC: 2300/uL, with a predominance of polymorphonuclear leukocytes Polarized light microscopy: Uric acid crystals are seen Microscopy: no abnormalities Gram stain: negative Culture results will be available in 3 days

Urea & Creatinine

Urea: 5.5 mmol/L (2.5-6.7) Creatinine: 1 mg/dl (0.8-1.4)

Step 3: Select appropriate management

IV Antibiotics
Reduce drinking

Score: ★★☆