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Retired NBME 19 Answers

nbme19/Block 3/Question#49 (reveal difficulty score)
A 60-year-old woman is brought to the ...
Gout 🔍 / 📺 / 🌳 / 📖
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submitted by surgerydoctorca_sgu(6)
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This question is testing your knowledge on gout.

In the question stem the examiners are showing you a picture of a hand with extensive tophus formations (often these appear on the external ear, olecranon bursa, or Achilles tendon).

Strongest risk factor for acquiring gout is hyperuricemia, which can be caused by:

  • Underexcretion of uric acid (90% of patients)—largely idiopathic, potentiated by renal failure; can be exacerbated by certain medications (eg, thiazide diuretics).
  • Overproduction of uric acid (10% of patients)—Lesch-Nyhan syndrome, PRPP excess, 􏰂 cell turnover (eg, tumor lysis syndrome), von Gierke disease.

Treatment:

  • Acute: NSAIDs (eg, indomethacin), glucocorticoids, colchicine.
  • Chronic (preventive): xanthine oxidase inhibitors (eg, allopurinol, febuxostat).
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surgerydoctorca_sgu  (FA 2021, Pg. 479) For above referenced information. +1



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