Mr. Y is a 47 year old, mixed race [Asian/African ethnicity], male patient who presented to your office with severe right great toe pain

Mr. Y is a 47 year old, mixed race [Asian/African ethnicity], male patient who presented to your office with severe right great toe pain. Onset of the pain was 2 days ago. Mr. Y denies any known trauma to his right foot or his great toe on that foot. His right great toe is red and became so swollen in the last day that he cannot put on his shoe.

Mr. Y has a history of hypertension for which he is taking HCTZ 25mg daily, Metopralol 50 mg twice daily, and Lisinopril 10 mg daily. He denies any other medical problems.

Results of the lab tests that were ordered:

Sed rate – 93; Glucose, random – 117 mg/dl; Hgb – 13.4 gm/dl; WBC – 8200/ccm with normal diff; Serum uric acid – 10.9 mg/dl; Serum creatinine – 1.2 mg/dl