Which one of the following drugs may precipitate gout -a) Ethambutolb) Isoniazidc) Pyrazinamided) Rifampicin

## Core Concept
The question tests the understanding of drug-induced gout, a condition characterized by elevated uric acid levels leading to joint inflammation. Certain medications can interfere with uric acid metabolism or excretion, precipitating gout.

## Why the Correct Answer is Right
Pyrazinamide is known to interfere with uric acid excretion by the kidneys. It inhibits the organic anion transporters responsible for uric acid secretion in the proximal tubules, leading to decreased uric acid excretion and potentially causing hyperuricemia and gout.

## Why Each Wrong Option is Incorrect
* **Option A: Ethambutol** - Ethambutol is primarily associated with optic neuritis as a side effect, not commonly linked with gout or significant alterations in uric acid levels.
* **Option B: Isoniazid** - Isoniazid can cause liver toxicity and peripheral neuropathy but is not commonly associated with the precipitation of gout.
* **Option D: Rifampicin** - Rifampicin is known for inducing liver enzymes and can cause a flu-like syndrome, but it is not typically associated with gout.

## Clinical Pearl / High-Yield Fact
A key point to remember is that **pyrazinamide** and **diuretics** (especially thiazides) are classic causes of drug-induced gout due to their effects on uric acid levels.

## Correct Answer: C. Pyrazinamide