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Retired NBME 23 Answers

nbme23/Block 2/Question#49 (reveal difficulty score)
A 56-year-old man comes to the physician ...
Colchicine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +5  upvote downvote
submitted by โˆ—sympathetikey(1600)
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Acute gout treatment:

  1. NSAIDs
  2. Steroids
  3. Colchicine

I, like a dumby, misread -zone for -sone, thinking it was steroid picked that. For anyone who cares, Sulfinpyrazone competitively inhibiting uric acid reabsorption in the proximal tubule of the kidney.

Source: https://en.wikipedia.org/wiki/Sulfinpyrazone

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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 +6
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



 +1  upvote downvote
submitted by โˆ—dr.xx(176)
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Treatment of acute gouty arthritis Several drugs are effective for terminating the acute gouty attack. Colchicine, nonsteroidal anti-inflammatory drugs (NSAIDs), and corticosteroids are standard approaches. Adrenocorticotropic hormone (ACTH) is also very effective, but has become increasingly scarce or too expensive to be a practical alternative in the US. Regardless of the particular agent chosen, the sooner these drugs are started, the more rapid the response. If a patient cannot take NSAIDs or colchicine, the choice is among oral, intra-articular or parenteral glucocorticoids. Local application of ice packs may help control pain. In some cases, analgesics, including opioids, may be added.

Drugs that affect serum urate concentrations (E.G., ALLOPURINOL), including antihyperuricemic agents, should not be changed, started, or stopped during an attack, as this may worsen the inflammatory response already in progress.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3539261/

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



 +1  upvote downvote
submitted by โˆ—yotsubato(1208)
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Although acetaminophen (Tylenol) is not considered an NSAID, it too may provoke an aspirin-like sensitivity.

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meningitis  For that same reason (not an NSAID) it doesn't reduce inflammation so it cant be used for Gout. +7
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
an1  Actually, from what I recall from UW, acetaminophen actually is an NSAID... it only acts centrally though. From FA: "Reversibly inhibits cyclooxygenase, mostly in CNS. Inactivated peripherally." But for that reason, It wouldn't be helpful for gout because it can't do squat in the periphery, which is where gout accumulates. +
freemanpeng  link981 Are u blind? +



 +0  upvote downvote
submitted by โˆ—d_holles(218)
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Pt has ASA intolerance asthma, which means NSAID is contraindicated. Pick colchicine.

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 -1  upvote downvote
submitted by โˆ—brise(86)
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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

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brise  Acetaminophen is not an NSAID and therefore it will not treat gout. +1
meja2  Acetaminophen is not anti-inflammatory, only provides antipyretic & ani-pain effects. +



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