A 49-year-old man presents with painful, recurring episodes of swelling in his left great toe. He…

A 49-year-old man presents with painful, recurring episodes of swelling in his left great toe. He takes 25 mg of hydrochlorothiazide daily for blood pressure control but otherwise is in good health. On physical examination, the patient is afebrile, but his great toe is warm, swollen, erythematous, and exquisitely tender to palpation. He has several subcutaneous nodules in his pinna. Which of the following is the most likely cause of his discomfort? a. Calcium pyrophosphate dihydrate deposition disease b. Calcium oxalate deposition disease c. Monosodium urate deposition disease d. Calcium phosphate deposition disease e. Osteoarthritis of the great toe

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