A 50-year-old man presents with pain and swelling in his right big toe that started suddenly in the middle of the night. He also reports a recent alcohol binge and fruity-smelling breath. On examination, the affected joint is erythematous, swollen, and extremely tender. What is the most likely diagnosis? A) Osteoarthritis B) Gout C) Rheumatoid arthritis D) Septic arthritis E) Pseudogout Correct Answer: B) Gout Explanation: Gout is characterized by sudden onset of severe pain in the big toe (often at night), with erythema, swelling, and tenderness. It is associated with elevated uric acid levels and often triggered by alcohol ingestion or purine-rich foods. Osteoarthritis (A) presents with gradual onset of joint pain and is usually not associated with such acute symptoms or erythema. Rheumatoid arthritis (C) presents with symmetric joint involvement, and morning stiffness, but not typically with such acute and localized pain. Septic arthritis (D) involves fever, chills, and acute pain, but the affected joint would be extremely tender and there would be signs of infection (e.g., fever, elevated WBC). Pseudogout (E) is caused by calcium pyrophosphate crystals and usually affects larger joints like the knee rather than the big toe. Key Tips for PLAB 1: ✅ Sudden-onset pain in the big toe after alcohol binge = Gout ✅ Management = NSAIDs, colchicine, or corticosteroids during acute flares; uric acid-lowering therapy for long-term management
