input: The following are multiple choice questions (with answers) about medical knowledge.   **Question:** A 55-year-old man comes to the emergency department with the complaint of pain in his right toe for the past hour. The pain is so severe that it woke him up. The patient has smoked a pack of cigarettes daily for the last 40 years and binge drinks alcohol after work and on the weekends. He underwent an appendectomy when he was 14 years old. He is a long-distance truck driver. Neither of his parents had any significant medical history. His temperature is 37.7°C (100°F), blood pressure is 135/75 mm Hg, pulse is 102/min, respiratory rate is 20/min, and BMI is 25 kg/m2. On examination, his right first metatarsophalangeal joint is very tender, swollen, warm, and red in color. Range of motion cannot be assessed due to extreme tenderness. Laboratory test Complete blood count: Hemoglobin 11.5 g/dL Leukocytes 16,000/mm3 Platelets 150,000/mm3 ESR 50 mm/hr Synovial fluid is aspirated from the joint. The findings are: Appearance Cloudy, dense yellow WBC 30,000 cells/µL Culture Negative Needle-shaped birefringent crystals are observed in the joint aspirate. Which of the following is the most likely underlying cause of the patient’s condition?   (A) Organic acids competing with urate for tubular secretion   (B) Increased renal reabsorption of urate   (C) Deficiency of HGPRT   (D) High-purine diet
output: ['(A) Organic acids competing with urate for tubular secretion <> answer', 'The following are multiple choice questions (with answers) about medical knowledge. <> instruction', '(A) Organic acids competing with urate for tubular secretion  (B) Increased renal reabsorption of urate  (C) Deficiency of HGPRT  (D) High-purine diet <> possible answers', '  A 55-year-old man comes to the emergency department with the complaint of pain in his right toe for the past hour. The pain is so severe that it woke him up. The patient has smoked a pack of cigarettes daily for the last 40 years and binge drinks alcohol after work and on the weekends. He underwent an appendectomy when he was 14 years old. He is a long-distance truck driver. Neither of his parents had any significant medical history. His temperature is 37.7°C (100°F), blood pressure is 135/75 mm Hg, pulse is 102/min, respiratory rate is 20/min, and BMI is 25 kg/m2. On examination, his right first metatarsophalangeal joint is very tender, swollen, warm, and red in color. Range of motion cannot be assessed due to extreme tenderness.\nLaboratory test\nComplete blood count:\nHemoglobin 11.5 g/dL\nLeukocytes 16,000/mm3\nPlatelets 150,000/mm3\nESR 50 mm/hr\nSynovial fluid is aspirated from the joint. The findings are:\nAppearance Cloudy, dense yellow\nWBC 30,000 cells/µL\nCulture Negative\nNeedle-shaped birefringent crystals are observed in the joint aspirate. Which of the following is the most likely underlying cause of the patient’s condition? <> context']