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NBME 21 Answers

nbme21/Block 1/Question#15 (49.0 difficulty score)
A 35-year-old man comes to the physician ...
Increased vascular permeability๐Ÿ”,๐Ÿ“บ

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submitted by neonem(580),
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ishT is a caes fo tceua go.ut miduosnMoo retau satrlsyc rea ktean up yb ,peuroitlhns neldgia to an aeuct anltafroiymm .canieotr lsecl-T 'anetr lylaer vdioelvn ni outg omr(e ohumdrteai tiihrs)

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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eTh accttcihemo asrcfto coudedpr by neycsotmo nad tmsa cllse adn eth allco tonaoasdavtiil mlitasuest rpenlicuthio sxiath.cmoe A,lso oaltedhinle clsle aiavnottci reufthr gavsaagetr the miraltfaomyn epenosrs dna oarinmitg fo utlrh.nseiop sihT laesd ot na nfuilx of nuoprheilts

:rcnefree sivnnlb/i/1hw:/./2ertmt5cta5gsmp1i/w.npChM/o25Pclwc..

bronchophony  Why not complement activation? +2  
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) +2  
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. +1  

submitted by skip_lesions(12),

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