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NBME 23 Answers

nbme23/Block 2/Question#49 (32.8 difficulty score)
A 56-year-old man comes to the physician ...

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submitted by sympathetikey(1244),
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uecAt utgo mrtna:eett

  1. sINSAD
  2. eoidSsrt
  3. nilociCech

,I ilke a ud,mby marised nz-oe orf ,eson- kihnntgi ti was otesrdi dcpeik t.tah orF ynenoa owh r,ceas opynSzaeiulnrf timyceiltopve binhngiiti cuir cadi naboprreotis ni eth mlrpxoai uulbet fo eth dyikne.

eru:Sco hkds.wpprn/innewiae.frtigeyla/oikziutopS:/i/

yb_26  even if it would be steroid in the list, if NSAIDs are contraindicated => we give Colchicine, and if pt can't tolerate Colchicine as well => then we use steroids +4  
usmlecharserssss  uptodate - try to avoid steroid therapy in gout , in this case patient has aspirin (NSAID) allergy , so second line is Colchicine , not Allopurinol, which is for chronic management. This case is not RARE and a lot of people sits on Colchicine therapy even if they do not have NSAID problems. Colchicine also First line treatment for Familial Mediterranean Fever, prevent exacerbations. +4  

submitted by dr.xx(142),
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Teanermtt fo aucet otygu hriiveat laserSrt sdgru rea eifceftve rof agtiintmenr eht etacu uyotg .tkcata ceohCi,lnic ionotanrelsd mnyalatmi-ortnfia srdgu SIsD(A,N) adn oredccotistirso rea adnartsd aepcsor.hpa rpccdcrioteoAiontro moonher AT)H(C is osla veyr cieetev,ff tbu sha coebme iecnyirlasgn aecscr or too pniseexev to be a atlipcacr neteaarvtil in eht .SU segaesldRr fo het ractulirpa negta oehs,cn eth oensor heest ugrsd rea sed,ttra the eorm iadpr hte eorp.enss If a tpietna tcnano aket NSIDAs or ehni,ccoicl eht cheoci is amngo r,ola arruirtal-tcain or lprraatene rl.dotuciccisgoo lcaLo taipclanpoi of eic kscap amy lhpe ltcroon a.ipn nI msoe esc,sa cs,egsaalni ndlingcui spidio,o mya be .added

sguDr htat eacftf usrme auert taretcnionncso .G,.(E AI,OOLRNUP)LL gciunlind nitypearcirheucim ,tnesga ulhods ont be nedhgc,a raesd,tt ro pdpesto idrgnu an ackat,t as thsi may wrenos het rtimafmnyloa sepesorn lyaaedr in r.srgepos


nwinkelmann  Love the last quote/sentence from the article! So helpful for clinical decision making! +  

submitted by yotsubato(961),
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uhhltgAo intnhaoeampec olel(ynT) is ont eecddosrni an N,SIAD it oot amy eopokvr an li-inerapkis tsiieistvyn.

meningitis  For that same reason (not an NSAID) it doesn't reduce inflammation so it cant be used for Gout. +5  
meningitis  And I think Indomethacin is associated with anaphylactic reactions in patients with aspirin-sensitive asthma and aspirin allergies. Can anyone confirm? +  
link981  How many other's like me didn't see "allergic to aspirin"? FML +3  
hyperfukus  OMFG me too i just got so mad and questioned my whole life at least its cuz i can't read not bc i don't understand :((((( +1  

submitted by d_holles(170),
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tP hsa AAS ntrclaneeoi mstah,a cwhih smaen IASND si tcnr.acdetodaiin cikP .hoiecicncl

submitted by brise(44),

Why is it that you can use acetaminophen in aspirin induced asthma and not here? I literally chose acetaminophen bc in another nbme it said to use it in aspirin induced asthma

brise  Acetaminophen is not an NSAID and therefore it will not treat gout. +1