question: Q:A 41-year-old man presents to the office with pain in his right big toe. The pain started yesterday and has been progressively getting worse to the point that it is difficult to walk. He describes his right big toe as being swollen and hot to the touch. He has never had symptoms like this before. He drinks 3 beers per night. Medical history is otherwise significant for chronic kidney disease. Physical examination is notable for an overweight gentleman in moderate pain, with an erythematous, swollen and tender right toe. He is afebrile. A joint fluid analysis in this patient is most likely to show what?? 
  {'A': 'Gram negative diplococci', 'B': 'Negatively birefringent crystals', 'C': 'Positively birefringent crystals', 'D': 'Glucose < 40 mg/dL', 'E': 'Normal'},