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NBME 21 Answers

nbme21/Block 1/Question#15 (46.3 difficulty score)
A 35-year-old man comes to the physician ...
Increased vascular permeabilityπŸ”,πŸ“Ί

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submitted by neonem(572),
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sihT is a case of uteca uoMnosdmio rteua yscastlr rea atnke up by rshupil,ntoe dgnalie to an eucta loamanymfrit T-lsecl tn'ear lrleay niovdvel ni utgo moer( amdoeuhtri at)trs.ihir

hungrybox  Great explanation! So frustrating that I got this wrong, should have been easy. +3  
temmy  the way i thought about it was how did the neutrophils get there? the answer is via increased vascular permeability +16  
nor16  they, unfortunately, did not ask " how did neutrophils get there" but " whats the cause of the swelling " not to confuse with " what causes the swelling " +1  
divya  absolutely right temmy. that's how i thought about it too. +  

submitted by sweetmed(144),
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heT cthctaocmie crostaf oddreucp yb snyteocmo nad tsam llcse adn teh lcola iasaiotntdaovl mtaseulsit ipilcnhureot eicsx.atmho Alo,s deltlnhaoie lslec ntatoiaciv ferhurt tregasgava hte ylafmotamnri snseoerp nda initgmaor of np.lhsiuerot hisT delas to an luifxn fo rpelosuihnt lla.ycol

nrcefee:r n1cMisvpp.mb//irmntlgP./ol.2t5tic.1/cChh:wws5nw//2ea5

bronchophony  Why not complement activation? +1  
joyceeepan  the way i though about it was: you need antibodies (IgG/IgM) to activate the complement system. But there's no such a thing as an anti-gout antibody. (and it is not an infection neither) +1  
an_improved_me  Thats not exactly true for a couple reasons. I saw a UWorld question that said something along the lines of an ApoProtein being useful b/c it binds the urate crystals, and makes it less likely for the crystals to be opsinized/recognized by neutrophils. Therefore, Abs do play a role. Secondly, you can have activation of coplement via the alternative pathway, which does not require ABs. +  

submitted by skip_lesions(11),

Can't histamine also cause swelling or is it just not involved in the pathology of gout?

zevvyt  yes. Histamine causes vasodilation and increased vessel permeability. But it's not involved in Gout. Gout is more about Neutrophils and Macrophages activating eachother and not really about Mast cells. +3