Gout MCQs With Answer

Gout MCQs With Answer are an essential study tool for B. Pharm students preparing for exams in pharmacology and therapeutics. This concise set focuses on pathophysiology, diagnostic criteria, pharmacotherapy, drug mechanisms, adverse effects, and clinical management of gout. Coverage includes xanthine oxidase inhibitors, uricosurics, anti-inflammatory agents, and newer biologics, plus important drug interactions and renal considerations. Each question emphasizes practical knowledge useful in dispensing, counseling, and clinical decision-making. Ideal for revision or self-assessment, these questions reinforce core concepts like urate handling, crystal identification, and guideline-based targets for serum uric acid. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which crystal is characteristic of gout when examined under polarized light microscopy?

• Calcium pyrophosphate dihydrate crystals
• Monosodium urate crystals
• Hydroxyapatite crystals
• Calcium oxalate crystals

Correct Answer: Monosodium urate crystals

Q2. What is the typical appearance of monosodium urate crystals under polarized light?

• Rod-shaped, positively birefringent
• Needle-shaped, negatively birefringent
• Rhomboid-shaped, positively birefringent
• Plate-like, non-birefringent

Correct Answer: Needle-shaped, negatively birefringent

Q3. Which enzyme catalyzes the final steps of purine degradation to uric acid?

• Purine nucleoside phosphorylase
• Adenosine deaminase
• Xanthine oxidase
• Hypoxanthine guanine phosphoribosyltransferase

Correct Answer: Xanthine oxidase

Q4. Allopurinol primarily reduces serum uric acid by which mechanism?

• Inhibiting urate reabsorption in renal tubules
• Inhibiting xanthine oxidase
• Enhancing uric acid excretion via urine alkalinization
• Activating uricase to degrade uric acid

Correct Answer: Inhibiting xanthine oxidase

Q5. Which metabolite of allopurinol contributes to its pharmacologic effect?

• Oxypurinol (alloxanthine)
• Thiouric acid
• Febuxostat
• Urate oxidase

Correct Answer: Oxypurinol (alloxanthine)

Q6. Which drug is a selective non-purine xanthine oxidase inhibitor used when allopurinol is not tolerated?

• Probenecid
• Colchicine
• Febuxostat
• Indomethacin

Correct Answer: Febuxostat

Q7. What is the main mechanism of action of probenecid in gout therapy?

• Inhibiting xanthine oxidase
• Inhibiting tubule reabsorption of urate increasing excretion
• Breaking down urate crystals enzymatically
• Suppressing neutrophil chemotaxis

Correct Answer: Inhibiting tubule reabsorption of urate increasing excretion

Q8. Which agent is contraindicated in patients with a history of uric acid kidney stones?

• Allopurinol
• Probenecid
• Colchicine
• Prednisolone

Correct Answer: Probenecid

Q9. What is the recommended acute first-line therapy for an uncomplicated gout attack in a patient without contraindications?

• Allopurinol immediately
• NSAIDs such as indomethacin
• Probenecid
• Pegloticase

Correct Answer: NSAIDs such as indomethacin

Q10. Which anti-inflammatory drug used in acute gout binds to tubulin and inhibits microtubule polymerization?

• Colchicine
• Ibuprofen
• Allopurinol
• Febuxostat

Correct Answer: Colchicine

Q11. Severe myopathy is a risk when colchicine is combined with which class of drugs?

• Calcium channel blockers
• Statins and CYP3A4 inhibitors
• Beta blockers
• Loop diuretics

Correct Answer: Statins and CYP3A4 inhibitors

Q12. Which of the following is a life-threatening adverse reaction associated with allopurinol?

• Peripheral neuropathy
• Allopurinol hypersensitivity syndrome (AHS) with rash and renal failure
• Hematologic hyperproliferation
• Depression

Correct Answer: Allopurinol hypersensitivity syndrome (AHS) with rash and renal failure

Q13. Which genetic marker is associated with increased risk of allopurinol hypersensitivity in certain populations?

• HLA-B*5801
• CYP2C9*3
• HLA-A*0201
• UGT1A1*28

Correct Answer: HLA-B*5801

Q14. During an acute gout attack, when should urate-lowering therapy (e.g., allopurinol) generally be initiated according to guidelines?

• Immediately during the acute attack
• Once the acute attack has resolved
• Only after 10 years of gout
• Never; urate-lowering therapy is not recommended

Correct Answer: Once the acute attack has resolved

Q15. What serum uric acid target is typically recommended for patients with gout to reduce flare risk?

• Less than 10 mg/dL
• Less than 8 mg/dL
• Less than 6 mg/dL
• Less than 4 mg/dL

Correct Answer: Less than 6 mg/dL

Q16. Which gout medication is a recombinant uricase used for refractory chronic gout with tophi?

• Pegloticase
• Allopurinol
• Probenecid
• Colchicine

Correct Answer: Pegloticase

Q17. Which adverse effect is most commonly associated with colchicine therapy?

• Hepatotoxicity
• GI upset, especially diarrhea
• Hypertension
• Hyperglycemia

Correct Answer: GI upset, especially diarrhea

Q18. Which diuretic class is most strongly associated with increased gout risk due to decreased uric acid excretion?

• Loop diuretics and thiazides
• Potassium-sparing diuretics only
• Carbonic anhydrase inhibitors
• Osmotic diuretics

Correct Answer: Loop diuretics and thiazides

Q19. A patient on allopurinol is prescribed azathioprine. What interaction concern exists?

• Allopurinol reduces azathioprine efficacy
• Allopurinol increases azathioprine toxicity by inhibiting its metabolism
• They have no interactions
• Azathioprine increases uric acid production

Correct Answer: Allopurinol increases azathioprine toxicity by inhibiting its metabolism

Q20. Which diagnostic test is definitive for diagnosing gout?

• Serum uric acid measurement alone
• Synovial fluid aspiration with crystal analysis
• Serum creatinine measurement
• Plain radiography of the joint

Correct Answer: Synovial fluid aspiration with crystal analysis

Q21. During an acute attack, serum uric acid levels may be:

• Consistently elevated and diagnostic
• Normal or low and not exclude gout
• Always below normal
• Irrelevant and never measured

Correct Answer: Normal or low and not exclude gout

Q22. Which lifestyle modification can help reduce gout flares?

• High-purine diet
• Excessive alcohol, especially beer
• Weight loss and reduced alcohol intake
• Increased red meat consumption

Correct Answer: Weight loss and reduced alcohol intake

Q23. Which drug class provides rapid relief in severe monoarticular gout when NSAIDs are contraindicated?

• Systemic corticosteroids
• Uricosurics
• Xanthine oxidase inhibitors
• Topical antihistamines

Correct Answer: Systemic corticosteroids

Q24. What is the principal reason to use low-dose colchicine prophylactically when initiating urate-lowering therapy?

• To increase uric acid production
• To prevent flares due to mobilization of urate stores
• To potentiate xanthine oxidase inhibition
• To treat hypertension

Correct Answer: To prevent flares due to mobilization of urate stores

Q25. Which lab abnormality increases the risk of gout and affects drug dosing for many gout medications?

• Hypokalemia
• Renal impairment (reduced eGFR)
• Leukocytosis
• Hypernatremia

Correct Answer: Renal impairment (reduced eGFR)

Q26. Which agent is contraindicated in severe renal impairment for uricosuric action?

• Probenecid
• Allopurinol
• Colchicine
• Prednisone

Correct Answer: Probenecid

Q27. Which medication class can precipitate gout when used for cancer chemotherapy-induced tumor lysis syndrome?

• Allopurinol prevents uric acid but is not precipitating
• Uricase (rasburicase) increases uric acid
• Purine analogs increase nucleic acid breakdown causing hyperuricemia
• Antimetabolites reduce uric acid production

Correct Answer: Purine analogs increase nucleic acid breakdown causing hyperuricemia

Q28. Febuxostat has a boxed warning about increased risk of:

• Hepatic failure
• Cardiovascular events in patients with existing CVD
• Neurotoxicity
• Severe hypoglycemia

Correct Answer: Cardiovascular events in patients with existing CVD

Q29. Which drug increases renal clearance of other drugs by competing for tubular secretion and may reduce antibiotic excretion?

• Allopurinol
• Probenecid
• Colchicine
• Indomethacin

Correct Answer: Probenecid

Q30. Long-term management of gout aims primarily to:

• Eliminate all dietary purines completely
• Reduce serum urate to a target value and prevent flares and tophi
• Use NSAIDs indefinitely to prevent attacks
• Avoid all medications

Correct Answer: Reduce serum urate to a target value and prevent flares and tophi

Q31. Which condition is known as “pseudogout” and often confused with gout clinically?

• Monosodium urate deposition disease
• Calcium pyrophosphate deposition disease
• Rheumatoid arthritis
• Septic arthritis

Correct Answer: Calcium pyrophosphate deposition disease

Q32. Which imaging finding is characteristic of chronic tophaceous gout on X-ray?

• Periarticular erosions with overhanging edges and tophi
• Uniform joint space narrowing with osteophytes
• Diffuse osteopenia without erosions
• Calcified menisci only

Correct Answer: Periarticular erosions with overhanging edges and tophi

Q33. Which medication should be dose-reduced or used cautiously in renal impairment due to accumulation and toxicity risk?

• Febuxostat (no dose adjustment usually required)
• Oxypurinol (active metabolite of allopurinol)
• Pegloticase (no renal dose adjustment)
• Corticosteroids (systemic)

Correct Answer: Oxypurinol (active metabolite of allopurinol)

Q34. Which of the following is true regarding prophylactic use of low-dose colchicine when starting allopurinol?

• It is unnecessary and increases flares
• It decreases the odds of gout flares during ULT initiation
• It cures gout within days
• It raises serum uric acid

Correct Answer: It decreases the odds of gout flares during ULT initiation

Q35. Which biomarker measurement is most useful to monitor effectiveness of urate-lowering therapy?

• Serum creatinine
• Serum uric acid concentration
• C-reactive protein only during attack
• Serum calcium

Correct Answer: Serum uric acid concentration

Q36. Rasburicase is mainly used in which clinical scenario rather than chronic gout management?

• Chronic tophaceous gout maintenance therapy
• Tumor lysis syndrome to lower uric acid rapidly
• Prophylaxis for cardiovascular disease
• Long-term uricosuric therapy in renal stones

Correct Answer: Tumor lysis syndrome to lower uric acid rapidly

Q37. Why is urine alkalinization sometimes recommended in gout management?

• To decrease uric acid solubility and promote stone formation
• To increase uric acid solubility and reduce stone risk
• To enhance xanthine oxidase activity
• It has no effect on uric acid solubility

Correct Answer: To increase uric acid solubility and reduce stone risk

Q38. Which drug reduces production of uric acid and should be used cautiously with azathioprine or mercaptopurine?

• Probenecid
• Allopurinol
• Colchicine
• Indomethacin

Correct Answer: Allopurinol

Q39. Which of the following best describes the intercritical period in gout?

• The initial acute inflammatory phase
• Asymptomatic interval between acute attacks
• Chronic tophaceous stage only
• Presence of septic arthritis with infection

Correct Answer: Asymptomatic interval between acute attacks

Q40. Which of the following increases risk of gout due to increased purine turnover?

• High intake of vitamin C
• Alcohol binge, especially beer and spirits
• Dietary dairy intake
• Regular exercise

Correct Answer: Alcohol binge, especially beer and spirits

Q41. Which statement about febuxostat pharmacology is correct?

• It is a purine analog xanthine oxidase inhibitor like allopurinol
• It is a non-purine selective xanthine oxidase inhibitor
• It is a potent uricosuric agent acting on URAT1
• It enzymatically degrades uric acid to allantoin

Correct Answer: It is a non-purine selective xanthine oxidase inhibitor

Q42. Which transporter is a major target for uricosuric drugs to inhibit urate reabsorption?

• OAT1
• URAT1
• PEPT1
• GLUT2

Correct Answer: URAT1

Q43. Which clinical feature is most suggestive of gout rather than rheumatoid arthritis?

• Symmetric small joint polyarthritis
• Migratory muscle pain without joint swelling
• Sudden onset of severe pain in the first metatarsophalangeal joint
• Morning stiffness lasting several hours

Correct Answer: Sudden onset of severe pain in the first metatarsophalangeal joint

Q44. Which preventive medication may be continued during an acute gout attack according to modern guidelines?

• Start allopurinol only during attack
• Continue chronic urate-lowering therapy if already established
• Stop all medications during attack
• Begin probenecid during every acute episode

Correct Answer: Continue chronic urate-lowering therapy if already established

Q45. Tophi are best described as:

• Areas of calcium deposition in cartilage
• Aggregates of monosodium urate crystals in soft tissues
• Viral inclusions in synovium
• Granulomas formed by tuberculosis

Correct Answer: Aggregates of monosodium urate crystals in soft tissues

Q46. Which laboratory change is commonly monitored to detect allopurinol toxicity early?

• Platelet count and liver function tests only
• Complete blood count and liver and renal function tests
• Serum sodium exclusively
• Fasting blood glucose only

Correct Answer: Complete blood count and liver and renal function tests

Q47. Which medication class is useful for short-term prophylaxis against gout flares when starting urate-lowering therapy?

• Long-acting benzodiazepines
• Low-dose colchicine or low-dose NSAID
• High-dose allopurinol initially
• Antibiotics

Correct Answer: Low-dose colchicine or low-dose NSAID

Q48. A patient with gout and frequent uric acid kidney stones would best be treated with which strategy?

• Probenecid to increase uric acid excretion
• Urine alkalinization and xanthine oxidase inhibitor
• High-purine diet to dissolve stones
• Stop allopurinol and rely on NSAIDs only

Correct Answer: Urine alkalinization and xanthine oxidase inhibitor

Q49. Which of the following is a mechanism by which alcohol increases gout risk?

• Decreases purine turnover
• Increases lactate production which decreases uric acid excretion
• Directly inhibits xanthine oxidase
• Enhances uric acid renal clearance

Correct Answer: Increases lactate production which decreases uric acid excretion

Q50. Which patient characteristic requires HLA-B*5801 testing before starting allopurinol in some guidelines?

• Young age under 20
• Ethnicity with high risk, e.g., Han Chinese, Korean, or Thai ancestry
• History of asthma only
• Female sex only

Correct Answer: Ethnicity with high risk, e.g., Han Chinese, Korean, or Thai ancestry

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