A 75-year-old man presents to the surgical unit with a 24-hour history of acuteonset left loin pain, which seems to worsen intermittently and has not settled with regular simple analgesia. He suffers from mild dementia and is unable to recall the details of his past medical history. The foundation year 2 doctor on call suspects that a urinary calculus is the cause of this man’s pain and spots an old pathology repo in the patient’s notes showing the presence of negatively birefringent crystals in a synol fluid aspirate. Which one of the following substances is likely to make up the majority of this man’s calculus?
A 75-year-old man presents to the surgical unit with a 24-hour history of acuteonset left loin pain, which seems to worsen intermittently and has not settled with regular simple analgesia. He suffers from mild dementia and is unable to recall the details of his past medical history. The foundation year 2 doctor on call suspects that a urinary calculus is the cause of this man’s pain and spots an old pathology repo in the patient’s notes showing the presence of negatively birefringent crystals in a synol fluid aspirate. Which one of the following substances is likely to make up the majority of this man’s calculus?
π‘ Explanation
## **Core Concept**
The patient's presentation of acute-onset loin pain suggests a renal colic, commonly caused by a urinary calculus (kidney stone). The presence of negatively birefringent crystals in a synovial fluid aspirate is indicative of **Monosodium Urate (MSU) crystals**, which are associated with gout.
## **Why the Correct Answer is Right**
The identification of negatively birefringent crystals in a synovial fluid aspirate is diagnostic of gout, which is caused by the deposition of **Monosodium Urate (MSU) crystals**. Patients with gout are at an increased risk of developing **Uric Acid stones**, which are one type of kidney stone. Uric acid stones are often associated with gout and can be a manifestation of the same underlying metabolic issue.
## **Why Each Wrong Option is Incorrect**
* **Option A:** Calcium oxalate stones are the most common type of kidney stone but are not directly related to the presence of negatively birefringent MSU crystals.
* **Option B:** Cystine stones are associated with cystinuria, a genetic disorder, and are not directly linked to gout or MSU crystals.
* **Option D:** Struvite stones are often associated with urinary tract infections (UTIs) and are not directly related to gout.
## **Clinical Pearl / High-Yield Fact**
A key clinical pearl is that patients with gout are at increased risk of developing uric acid kidney stones. The presence of MSU crystals in synovial fluid or tophi is a diagnostic feature of gout, and this condition can guide the suspicion towards uric acid nephrolithiasis.
## **Correct Answer:** C. Uric Acid.
β Correct Answer: B. Uric acid
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