John, 42-year-old bus driver, awoke during the night two days prior to the office visit with an excruciatingly painful left first metatarso-phalangeal joint to the point that he was unable to weight bear. He had to walk into the office using a cane.

Upon questioning:

• Father had gout
• John drinks two beers after work every day
• Eats primarily barbecued hamburgers and steaks
• Obese
• History of hypertriglyceridemia
• Taking hydrochlorothiazide 12.5 mg qd for hypertension
• No other significant medical problems.

Other history:

• An episode of "eye inflammation" 10 years ago
• Father has a history of back pain that has lasted for many years and he now has a "stiff back."

  What is the differential diagnosis? Check all that apply.

  	Bacterial infection
  	Crystal arthritis
  	Reactive arthritis
  	Trauma
  	(Submit)

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