A 56-Year-Old Man Comes to the Physician Because of a 1-Day

A 56-year-old man comes to the physician because of a 1-day history of sudden severe pain in his right great toe. He has never had such symptoms before. Four months ago, He has a history of nephrolithiasis and hypertension treated with hydrochlorothiazide. Examination shows erythema, swelling, warmth, and tenderness of the right metatarsophalangeal joint; range of movement is limited by pain. His serum uric acid is 12 mg/dL. Needle aspiration of the joint is performed.  Which of the following is the most likely finding on analysis of this patient's synovial fluid?

A) Clear fluid with few white blood cells
B) Gram-negative diplococci
C) Gram-positive cocci in clusters
D) Many leukocytes with no crystals or organisms
E) Needle-shaped, negatively birefringent crystals
F) Numerous red blood cells
G) Rhomboid-shaped, positively birefringent crystals