Which patient below is at greatest risk for developing gout?

Choice A reason: Melena, dark tarry stools from digested blood, indicates upper gastrointestinal bleeding, not typically GERD. GERD involves acid reflux causing esophageal irritation, not bleeding severe enough for melena. This statement is inaccurate, as melena is more associated with ulcers or varices, not reflux disease.

Choice B reason: Heartburn, a burning sensation in the chest, is a hallmark of GERD, caused by stomach acid refluxing into the esophagus, irritating the mucosa. It results from lower esophageal sphincter dysfunction, allowing acid backflow. This statement is accurate, as heartburn is a primary diagnostic symptom of GERD.

Choice C reason: Hematemesis, vomiting blood, is not a common GERD symptom but indicates severe conditions like esophageal varices or ulcers. While chronic GERD may lead to esophagitis, bleeding is rare. This statement is inaccurate, as hematemesis is not a characteristic feature of typical GERD presentations.

Choice D reason: Dysphagia, difficulty swallowing, can occur in severe GERD due to esophageal strictures or motility issues but is not a primary characteristic. Heartburn is more common and diagnostic. This statement is less accurate, as dysphagia is a complication, not a defining feature of GERD.

Choice A reason: Trimethoprim/sulfamethoxazole does not require extended sun exposure. In fact, it causes photosensitivity, increasing sunburn risk, so patients should avoid prolonged sunlight. Vitamin D synthesis is unrelated to this antibiotic’s mechanism or side effects, making this statement inaccurate and potentially harmful for patient safety.

Choice B reason: Trimethoprim/sulfamethoxazole does not typically cause brown urine. Brown urine may indicate hematuria or other conditions, but it is not a common side effect of this drug. The medication may cause gastrointestinal upset or rash, but urine discoloration is not expected, making this statement inaccurate.

Choice C reason: Follow-up with a healthcare provider is necessary to ensure UTI resolution and monitor for side effects like rash, renal impairment, or rare hematologic effects. This statement is inaccurate, as lack of follow-up could miss treatment failure or complications, undermining effective management of the infection.

Choice D reason: Trimethoprim/sulfamethoxazole can cause bone marrow suppression, leading to anemia, particularly in patients with folate deficiency or prolonged use. Monitoring complete blood counts is critical to detect hemolytic anemia or other hematologic toxicities, making this statement accurate and essential for safe patient management during treatment.