A 45-year-old male presents to your office complaining of left knee pain that started last night

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A 45-year-old male presents to your office complaining of left knee pain that started last night. He says that the pain started suddenly after dinner and was severe within a span of three hours. He denies any trauma, fever, systemic symptoms, or prior similar episodes. It is a history of hypertension when she takes hydrochlorothiazide. He admits to consuming a great amount of wine last night with dinner.

On examination, his temperature is 98.0 Fahrenheit, his pulse is 90 bpm, his respirations are 22 bpm, and his blood pressure is 129/88. Heart and lung examinations are unremarkable. The patient is reluctant to flex the left knee wincing in pain at touch and has passive range of motion. The knee is edematous, hot to touch and has erythema of the overlying skin. No capitation or deformity is apparent. No other joints are involved. Inguinal lymph nodes are not enlarged. Complete what cannot reveals a white blood cell count of 10,900 this otherwise normal.

1. What is the next diagnostic step?

2. What is the most likely diagnosis? 

3. What is the next step in therapy?