A 36-Year-Old Man Comes to the Emergency Department Due to Severe

question 92

Multiple Choice

A 36-year-old man comes to the emergency department due to severe, acute knee pain that awoke him from sleep.  He has a history of end-stage renal disease for which he underwent a renal transplant 8 weeks ago.  The patient takes an immunosuppressive regimen that includes cyclosporine and low-dose prednisone.  He visited his nephrologist last week and serum creatinine levels were normal with no proteinuria.  Temperature is 37.5 C (99.5 F) , blood pressure is 136/78 mm Hg, and pulse is 88/min.  Examination shows redness, warmth, and a small effusion in the left knee.  Passive range of motion at the knee causes severe pain.  Microscopic examination of joint fluid from the knee shows numerous neutrophils as well as both intra- and extracellular crystals as shown in the exhibit. 

Which of the following mechanisms is most likely responsible for this patient's acute symptoms?

• A)Decreased urinary excretion of uric acid
• B)Increased production of uric acid
• C)Rapid drop in blood uric acid levels
• D)Release of nucleic acids from apoptotic cells
• E)Volume depletion and decreased renal perfusion

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Definitions:

General Fund

The primary operating fund of a government, covering general operations and services not accounted for in special-purpose funds.

Direct Increase

A rise in the value or quantity of something without intervening steps or intermediaries.

Endowment Fund

A fund where the principal amount is kept intact while the investment income is available for use, typically for the ongoing support of an organization.

General Fund

A main operating fund in governmental accounting, covering most basic services and activities.