NBME Step 2 CK Form 6 Indomethacin (NBME Answers)

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Retired NBME Step 2 CK Form 6 Answers

step2ck_form6/Block 4/Question#14 (reveal difficulty score)
A 57-year-old man comes to the physician ...
Indomethacin 🔍 / 📺 / 🌳 / 📖
tags: Pharm inc

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submitted by ∗medgirl11(20)

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Do not be tricked by using allopurinol during acute gout attack...it should be use as prophylaxis

During acute attack use NSAID (like indomethacin)

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sassy_vulpix Why not Prednisolone? +1

lubdub Not first line. First, NSAID, then better NSAID. +1

lubdub Then colchicine, thennnnnn you get to the 'roids. +1

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submitted by ∗step_prep7(71)

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Middle-aged man who presents with atraumatic right knee arthritis found to have cloudy synovial fluid with a WBC count of 9000 (normal synovial fluid has <200 WBCs) and negatively birefringent, needle-shaped crystals which are classic for acute gout
Key idea: Acute gout should be treated with NSAIDs (often indomethacin) and patients should NOT be started on chronic gout drugs (allopurinol, probenecid, etc.) until the acute flare has resolved because these drugs can lead to rapid shifts in uric acid levels that can exacerbate/cause a new flare
Note: Patients can sometimes be given oral or intra-articular steroids, but NSAIDs are tried first due to lower risk and good effectiveness in the majority of patients

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