In a few sentences, explain the gap in your knowledge of Musculoskeletal/Dermatology you are

addressing, list the resources used to address this gap, and explain why these resources are reliable.

I do not know much about Gouty arthritis. We learned the drugs used to treat it such as allopurinol but I
am more curious to see what are some of the risk factors for cause it.

Some resources that I would use are

1) Arthrits foundation 0 the official organization about arthritis symptoms. Their article about goit
is a good basis to learn about the information as it gives a simple explanation of gout
http://www.arthritis.org/about-arthritis/types/gout/

2) Up to Date, is another great resource because it uses peer reviewed article to help provide a
simple to read compilation of information that are more patient oriented.
https://www.uptodate.com/contents/gout-beyond-the-basics

Write an NBME-style multiple choice question with 5 answer choices and provide rationales for the
correct and incorrect answers.

A 90 year old man comes to the emergency department with a chief complaint of R Knee pain. On
examination it is noted that the patient has redness and swelling of the R knee. He states that this
episode occurred suddenly when he was mowing the lawn. He reports that he is currently on a
“medication that kills his cancer”. On examination, the knee is hot, swollen, and pain on movement. If a
needle aspirate of the R knee was performed, what would most likely be found upon analysis of the
fluid?

A) Purulent fluid with Strap Aureus

B) Transparent fluid with no WBC
C) Cloudy fluid with RBC
D) Rhomboid shaped crystals
E) Needle shaped crystals

Answer is D – Patient has Gout arthritis. He has increased uric acid concentration due to tumor lysis
syndrome. Symptoms of acute joint pain with warmth point, point to this diagnosis. Synovial fluid will
show crystals that are composed of monosodium urate crystals. These crystals are needle shaped and
negatively birefringent

A) Staph aureus is more consistent with fever

B) Transparent fluid would likely been seen in osteoarthritis
C) RBC synovial fluid would be associated with trauma
D) Rhomboid shaped crystals would be seen in pseudgout (Calckum pyrophosphate)