A 55-year-old male presents with sudden onset of excruciating pain, redness, and swelling in his right great toe. Synovial fluid analysis is performed. Which of the following findings is most characteristic of gout?

Explanation

Gout is a crystalline arthropathy caused by the deposition of monosodium urate (MSU) crystals. The definitive diagnosis of gout is made by identifying these crystals in synovial fluid. MSU crystals are typically needle-shaped and exhibit strong negative birefringence under polarized light microscopy. Positively birefringent, rhomboid-shaped crystals are characteristic of pseudogout (calcium pyrophosphate deposition disease). High leukocyte count with predominantly lymphocytes is more suggestive of chronic inflammatory conditions or tuberculosis, while low glucose and high protein are non-specific findings that can be seen in various inflammatory or infectious arthritides but are not specific for gout.