question: Q:A 52-year-old man presents to the emergency department with severe pain of the left first metatarsophalangeal joint. He says that the pain started 3 hours ago and describes it as sharp in character. The pain has been so severe that he has not been able to tolerate any movement of the joint. His past medical history is significant for hypertension for which he takes a thiazide diuretic. His diet consists primarily of red meat, and he drinks 5 bottles of beer per night. On physical exam, his left first metatarsophalangeal joint is swollen, erythematous, and warm to the touch. Which of the following characteristics would be seen with the most likely cause of this patient's symptoms?? 
  {'A': 'Fractures with bony consolidations', 'B': 'Inflammatory pannus formation', 'C': 'Negatively birefringent crystals in the joint', 'D': 'Positively birefringent crystals in the joint', 'E': 'Subchondral sclerosis and osteophyte formation'},