Gout disease MCQs With Answer

Gout disease MCQs With Answer

Gout is a metabolic arthritis characterized by hyperuricemia and deposition of monosodium urate crystals in joints and soft tissues. This concise, exam-focused guide of gout disease MCQs with answer is tailored for B. Pharm students studying pharmacology, pathophysiology, diagnosis, and drug therapy. Questions cover mechanisms of action of urate-lowering agents (allopurinol, febuxostat, probenecid, pegloticase), acute management (NSAIDs, colchicine, steroids), adverse effects, drug interactions, and monitoring. Emphasis is placed on clinical decision-making, lab and imaging clues (synovial fluid, double-contour sign), and patient counseling for lifestyle modifications. Now let’s test your knowledge with 50 MCQs on this topic.

Q1. Which crystal type and birefringence pattern is diagnostic for gout on synovial fluid analysis?

• Rhomboid crystals, positively birefringent
• Needle-shaped crystals, negatively birefringent
• Calcium pyrophosphate crystals, negatively birefringent
• Needle-shaped crystals, positively birefringent

Correct Answer: Needle-shaped crystals, negatively birefringent

Q2. The primary biochemical abnormality that predisposes to gout is:

• Hypouricemia
• Hyperuricemia
• Hypercalcemia
• Hypokalemia

Correct Answer: Hyperuricemia

Q3. Which enzyme is directly inhibited by allopurinol to reduce uric acid production?

• Xanthine oxidase
• Adenine phosphoribosyltransferase
• Urate oxidase
• Hypoxanthine-guanine phosphoribosyltransferase

Correct Answer: Xanthine oxidase

Q4. A target serum uric acid level recommended for most gout patients on urate-lowering therapy is:

• Greater than 8 mg/dL
• Less than 3 mg/dL
• Less than 6 mg/dL
• Exactly 7 mg/dL

Correct Answer: Less than 6 mg/dL

Q5. Colchicine’s anti-inflammatory action in gout mainly involves:

• Inhibition of cyclooxygenase enzymes
• Stimulation of prostacyclin synthesis
• Microtubule inhibition reducing neutrophil migration
• Direct neutralization of urate crystals

Correct Answer: Microtubule inhibition reducing neutrophil migration

Q6. Which NSAID is commonly used as first-line acute therapy for gout attacks?

• Ibuprofen only
• Indomethacin or naproxen
• Aspirin at high dose
• Celecoxib as preferred first-line

Correct Answer: Indomethacin or naproxen

Q7. Which drug is contraindicated to initiate together with azathioprine due to increased toxicity risk?

• Allopurinol
• Colchicine
• Probenecid
• Naproxen

Correct Answer: Allopurinol

Q8. The “double contour sign” on musculoskeletal ultrasound indicates:

• Calcium deposition on cartilage
• Urate crystal deposition on the cartilage surface
• Synovial thickening due to rheumatoid arthritis
• Osteophyte formation in osteoarthritis

Correct Answer: Urate crystal deposition on the cartilage surface

Q9. Pegloticase is best described as:

• An oral xanthine oxidase inhibitor
• A recombinant uricase converting uric acid to allantoin
• A uricosuric that blocks URAT1 transporter
• A nonsteroidal anti-inflammatory drug

Correct Answer: A recombinant uricase converting uric acid to allantoin

Q10. Which adverse reaction is most associated with allopurinol and requires HLA-B*5801 testing in high-risk populations?

• Gastrointestinal bleeding
• Severe cutaneous adverse reactions (Stevens-Johnson syndrome)
• Renal tubular acidosis
• Pulmonary fibrosis

Correct Answer: Severe cutaneous adverse reactions (Stevens-Johnson syndrome)

Q11. Which diuretic class commonly increases gout risk by raising serum uric acid?

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

Correct Answer: Loop and thiazide diuretics

Q12. Probenecid’s mechanism in gout management is primarily:

• Inhibition of xanthine oxidase
• Enhancing renal excretion of uric acid (uricosuric)
• Converting uric acid to allantoin
• Blocking PGE2 synthesis

Correct Answer: Enhancing renal excretion of uric acid (uricosuric)

Q13. The saturation point of uric acid in plasma above which crystal deposition is more likely is approximately:

• 1 mg/dL
• 3.5 mg/dL
• 6.8 mg/dL
• 10 mg/dL

Correct Answer: 6.8 mg/dL

Q14. Which laboratory finding helps distinguish gout from septic arthritis?

• Leukocyte count in synovial fluid always normal in gout
• Needle-shaped negatively birefringent crystals present in gout synovial fluid
• Positive gram stain is typical of gout
• High glucose concentration in synovial fluid indicates gout

Correct Answer: Needle-shaped negatively birefringent crystals present in gout synovial fluid

Q15. During an acute gout attack, initiating long-term urate-lowering therapy is generally:

• Recommended immediately without prophylaxis
• Avoided until the acute attack has resolved or given with prophylaxis
• Contraindicated forever
• Only done using pegloticase

Correct Answer: Avoided until the acute attack has resolved or given with prophylaxis

Q16. Febuxostat differs from allopurinol because it is:

• An uricosuric agent
• A selective non-purine xanthine oxidase inhibitor with hepatic metabolism
• A recombinant enzyme therapy
• Primarily renally excreted unchanged

Correct Answer: A selective non-purine xanthine oxidase inhibitor with hepatic metabolism

Q17. Which lifestyle change is most likely to lower gout flares?

• Increasing intake of sugary sodas
• Regular alcohol, especially beer, consumption
• Weight loss and reducing high‑purine foods
• Increasing red meat intake

Correct Answer: Weight loss and reducing high‑purine foods

Q18. A major contraindication for pegloticase therapy is:

• History of gouty tophi
• G6PD deficiency due to hemolysis risk
• Renal impairment
• Mild hyperuricemia without symptoms

Correct Answer: G6PD deficiency due to hemolysis risk

Q19. Which monitoring parameter is most important when using allopurinol in a patient with renal impairment?

• Serum potassium
• Oxypurinol levels or dose adjustment based on renal function
• Serum calcium
• INR monitoring

Correct Answer: Oxypurinol levels or dose adjustment based on renal function

Q20. Which statement about aspirin and gout is accurate?

• Low-dose aspirin is uricosuric and reduces gout risk
• Low-dose aspirin decreases uric acid excretion and may raise uric acid
• Aspirin is the treatment of choice for acute gout
• Aspirin directly dissolves urate crystals

Correct Answer: Low-dose aspirin decreases uric acid excretion and may raise uric acid

Q21. The first-line pharmacologic prophylaxis to prevent gout flares when starting urate-lowering therapy is often:

• High-dose allopurinol immediately
• Short-term low-dose colchicine or NSAID prophylaxis
• Pegloticase for everyone
• High-dose prednisone indefinitely

Correct Answer: Short-term low-dose colchicine or NSAID prophylaxis

Q22. Which organ system toxicity is a recognized risk of febuxostat requiring monitoring?

• Cardiovascular events and liver function abnormalities
• Pulmonary fibrosis only
• Peripheral neuropathy exclusively
• Bone marrow suppression only

Correct Answer: Cardiovascular events and liver function abnormalities

Q23. Which of the following increases renal uric acid excretion and may be contraindicated in patients with urolithiasis?

• Allopurinol
• Probenecid
• Febuxostat
• Pegloticase

Correct Answer: Probenecid

Q24. Acute monoarticular pain of the first metatarsophalangeal joint is classically called:

• Rheumatoid arthritis
• Podagra
• Septic bursitis
• Psoriatic arthritis

Correct Answer: Podagra

Q25. Which investigational imaging technique specifically identifies urate deposits noninvasively?

• Plain radiography only
• Dual-energy CT (DECT)
• DEXA scan
• Fluoroscopy

Correct Answer: Dual-energy CT (DECT)

Q26. In gout pharmacotherapy, uricosuric agents like probenecid act primarily at which renal transporter?

• URAT1 (SLC22A12)
• NKCC2
• ENaC channel
• OAT1 only

Correct Answer: URAT1 (SLC22A12)

Q27. Which of the following is a common gastrointestinal adverse effect of colchicine overdose?

• Constipation without other symptoms
• Severe diarrhea, vomiting, and abdominal pain
• Asymptomatic elevated liver enzymes only
• Painless jaundice

Correct Answer: Severe diarrhea, vomiting, and abdominal pain

Q28. Which drug interaction is important when combining allopurinol with warfarin?

• Allopurinol greatly reduces warfarin INR consistently
• Allopurinol may potentiate warfarin effect via unknown mechanisms; monitor INR
• Allopurinol has no interaction with warfarin
• Allopurinol permanently reverses warfarin action

Correct Answer: Allopurinol may potentiate warfarin effect via unknown mechanisms; monitor INR

Q29. Which comorbidity is frequently associated with gout and must be screened in B. Pharm patient counseling?

• Hypothyroidism exclusively
• Metabolic syndrome including hypertension, obesity, diabetes
• Huntington’s disease
• Primary immunodeficiency only

Correct Answer: Metabolic syndrome including hypertension, obesity, diabetes

Q30. Which statement about uric acid and its solubility is correct?

• Uric acid is highly soluble at high concentrations
• At physiologic pH uric acid exists largely as urate ion, which crystallizes when supersaturated
• Solubility is independent of temperature
• Urate crystals dissolve easily at low temperatures in tissues

Correct Answer: At physiologic pH uric acid exists largely as urate ion, which crystallizes when supersaturated

Q31. Which antihyperuricemic strategy would be preferred in a patient with recurrent tophi and intolerance to allopurinol?

• Start high-dose aspirin
• Consider febuxostat or pegloticase depending on severity and CV risk
• Stop all therapy and observe
• Use only NSAIDs indefinitely

Correct Answer: Consider febuxostat or pegloticase depending on severity and CV risk

Q32. Which lab test is most useful for monitoring the long-term efficacy of urate-lowering therapy?

• Serum uric acid concentration
• ESR only
• Serum sodium
• Urine ketones

Correct Answer: Serum uric acid concentration

Q33. Which condition may produce articular crystals that are positively birefringent and are therefore not gout?

• Monosodium urate deposition
• Calcium pyrophosphate deposition (pseudogout)
• Septic arthritis with bacteria
• Fibromyalgia

Correct Answer: Calcium pyrophosphate deposition (pseudogout)

Q34. Which statement is true regarding initiating allopurinol therapy?

• Start at a high dose to rapidly lower uric acid
• Begin at a low dose and titrate up to reduce hypersensitivity risk and flares
• Dose does not need adjustment in renal impairment
• Allopurinol should never be combined with colchicine prophylaxis

Correct Answer: Begin at a low dose and titrate up to reduce hypersensitivity risk and flares

Q35. Which medication is commonly used for acute gout in patients with contraindications to NSAIDs and colchicine?

• Systemic corticosteroids (oral or intra-articular)
• Pegloticase infusion
• Allopurinol loading dose
• Probenecid as a single dose

Correct Answer: Systemic corticosteroids (oral or intra-articular)

Q36. Which of the following is a pharmacodynamic concern when combining colchicine with strong CYP3A4 inhibitors (e.g., clarithromycin)?

• Decreased colchicine levels causing inefficacy
• Increased colchicine levels causing toxicity (myopathy, neuropathy)
• Complete inactivation of clarithromycin
• No interaction occurs

Correct Answer: Increased colchicine levels causing toxicity (myopathy, neuropathy)

Q37. Long-standing gout can lead to which of the following tophi-related complications?

• Tophi are always asymptomatic and have no complications
• Tophi can cause joint destruction, deformity, and chronic pain
• Tophi prevent infections and are protective
• Tophi convert to bone and strengthen joints

Correct Answer: Tophi can cause joint destruction, deformity, and chronic pain

Q38. Which of the following is the recommended duration for gout prophylaxis after initiating urate-lowering therapy in patients without tophi?

• No prophylaxis needed
• Approximately 3 to 6 months
• One week only
• Life‑long high‑dose colchicine mandatory

Correct Answer: Approximately 3 to 6 months

Q39. Which lab abnormality is commonly seen during treatment with pegloticase?

• Marked eosinophilia always
• Rapid fall in serum uric acid with risk of infusion reactions and formation of anti-drug antibodies
• Steady increase in serum uric acid
• Exclusive renal failure in all patients

Correct Answer: Rapid fall in serum uric acid with risk of infusion reactions and formation of anti-drug antibodies

Q40. In gout management, which patient education point is correct regarding alcohol?

• Beer increases gout risk more than distilled spirits
• All alcoholic beverages reduce gout risk
• Alcohol has no effect on serum uric acid
• Red wine is the only safe alcohol

Correct Answer: Beer increases gout risk more than distilled spirits

Q41. Which drug increases the renal retention of uric acid and may precipitate gout when used chronically?

• Losartan
• Thiazide diuretics
• Fenofibrate
• Probenecid

Correct Answer: Thiazide diuretics

Q42. Which feature on plain radiograph is most suggestive of chronic gout?

• Uniform joint space narrowing in small joints
• Juxta-articular erosions with overhanging edges and sclerotic margins
• Periarticular osteophytes typical of gout
• Diffuse osteopenia only

Correct Answer: Juxta-articular erosions with overhanging edges and sclerotic margins

Q43. Which enzyme deficiency is associated with recurrent uric acid overproduction leading to gout?

• Glucose-6-phosphate dehydrogenase
• Hypoxanthine-guanine phosphoribosyltransferase (HGPRT) partial deficiency (Lesch-Nyhan spectrum)
• Phenylalanine hydroxylase
• Thymidine kinase deficiency

Correct Answer: Hypoxanthine-guanine phosphoribosyltransferase (HGPRT) partial deficiency (Lesch-Nyhan spectrum)

Q44. Which urate-lowering agent is primarily metabolized hepatically and may require caution in severe liver disease?

• Allopurinol
• Febuxostat
• Probenecid
• Hydrochlorothiazide

Correct Answer: Febuxostat

Q45. Which of the following conditions can falsely lower serum uric acid during an acute gout attack?

• Concurrent urinary tract infection only
• Acute inflammation with redistribution of uric acid into tissues causing transient normal or low serum uric acid
• Diurnal variation has no effect
• Fasting always raises uric acid dramatically

Correct Answer: Acute inflammation with redistribution of uric acid into tissues causing transient normal or low serum uric acid

Q46. Which medication used for gout can prolong the half-life of colchicine by inhibiting P-glycoprotein and CYP3A4, increasing toxicity risk?

• High-dose vitamin C
• Clarithromycin
• Naproxen at usual doses
• Allopurinol

Correct Answer: Clarithromycin

Q47. In patients with renal calculi due to uric acid, which therapy can help dissolve stones by alkalinizing the urine?

• Urine acidifiers like ascorbic acid
• Urine alkalinization with potassium citrate
• Thiazide diuretics only
• Allopurinol dissolves stones rapidly

Correct Answer: Urine alkalinization with potassium citrate

Q48. Which of the following is an appropriate step when a patient on long-term allopurinol develops a rash?

• Ignore the rash and continue therapy
• Assess severity; discontinue allopurinol if severe or signs of hypersensitivity and evaluate for SCAR
• Double the dose of allopurinol
• Add febuxostat without stopping allopurinol immediately

Correct Answer: Assess severity; discontinue allopurinol if severe or signs of hypersensitivity and evaluate for SCAR

Q49. Which dietary component is associated with increased uric acid production and gout risk?

• Low-fructose vegetables
• High-fructose corn syrup and sugary drinks
• Nonstarchy vegetables exclusively
• Drinking water frequently

Correct Answer: High-fructose corn syrup and sugary drinks

Q50. When treating chronic gout, which combination is appropriate to reduce flares during urate-lowering therapy initiation?

• Start allopurinol and stop colchicine abruptly
• Begin urate-lowering therapy and give low-dose colchicine or NSAID prophylaxis for several months
• Only lifestyle measures; never use prophylaxis
• Use pegloticase in all new gout patients with no prophylaxis

Correct Answer: Begin urate-lowering therapy and give low-dose colchicine or NSAID prophylaxis for several months

G S Sachin

I am a Registered Pharmacist under the Pharmacy Act, 1948, and the founder of PharmacyFreak.com. I hold a Bachelor of Pharmacy degree from Rungta College of Pharmaceutical Science and Research. With a strong academic foundation and practical knowledge, I am committed to providing accurate, easy-to-understand content to support pharmacy students and professionals. My aim is to make complex pharmaceutical concepts accessible and useful for real-world application.

Mail- Sachin@pharmacyfreak.com