Answer is B (Allopurinol should be staed immediately): Allopurinol should not be staed immediately in acute attack of gout as it may precipitate acute symptoms. The mainstay of treatment in acute gouty ahritis is the administration of anti inflammatory drugs such as NSAID, Cochicine and /or glucocoicoids. Allopurinol should not be staed immediately in Acute attack of Gout Allopurinol should never be staed in acute gout as it may actually precipitate an acute attack. Anti inflammatory drugs such as NSAIDs are the drugs of choice in acute gout. Joint aspirate typically reveals strongly negative birefringent needle shaped crystals Definitive diagnosis of gout requires aspiration of the involved joint and demonstration of intracellular monosodium urate crystals in synol fluid. Under polarized light these are demonstrated as "strongly negative birefringent needle shaped crystals." Tophi are aggregates of monosodium urate monohydrate crystals that form in extra aicular and aicular structures and cause deformity and destruction of hard and soft tissue. Serum uric acid levels may be normal in Acute Gout Gout is caused whenever; synol fluid is supersaturated with uric acid, irrespective of serum concentration of uric acid. The serum levels of uric acid can be normal or even low at the time of an attack and hence its determination is not diagnostic for gout. `Serum uric acid levels may be normal or low at the time of an acute attack, as inflammatory cytokines can be uricosuric and effective initiation of hypourecemic therapy can precipitate attacks. This limits the value of serum uric acid determination for the diagnosis of gout '- Harrison's 18th/2838