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NBME Step 2 CK Form 7 Answers

step2ck_form7/Block 1/Question#3 (reveal difficulty score)
A 52-year-old man comes to the physician ...
Indomethacin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: msk

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 +9  upvote downvote
submitted by โˆ—yotsubato(1208)

This one made no sense. Celecoxib is already the strongest NSAID. I would rather give Dexamethasone. Which works along a seperate mechanism of action.

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jaypat  Indomethacin is typically the first choice NSAID for acute gout flares. Then glucocorticoids. Lastly Colchicine +1
seagull  I also choose steroids since they were on a NSAID. fml +2
creamy  Naw dawg. Celecoxib has anti-inflammatory efficacy hence the categorization as a NSAID. In fact, gout patients treated with Celecoxib have the same treatment response as Indomethacin. Celecoxib is actually listed as an alternative to nonselective NSAIDs for acute gouty flares. This was just a bumbass question. +7
dreamyyn  I also chose Dexamethasone, but uptodate says the glucocorticoid choice is prednisone not dexamethasone. Indomethacin is typically the DOC, better than celecoxib. Not a good question, but a good review of details in the medication! +2
henoch280  ikr.... this was a stupid question +

 +1  upvote downvote
submitted by โˆ—jlbae(159)

Higher doses of celecoxib are needed to reach similar pain relief in acute gout compared to indomethacin.

FWIW, I picked dexamethasone too :(

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 +0  upvote downvote
submitted by โˆ—step_prep5(246)
  • Middle-aged man presents with acute onset, atraumatic pain of the great toe with swelling, erythema and tenderness of the metatarsophalangeal joint on exam, most consistent with acute gout
  • Key idea:ย Acute gout should be treated with NSAIDs (often indomethacin) and patients shouldย NOTย 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:ย 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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 -2  upvote downvote
submitted by โˆ—drdoom(1203)

โ€œItโ€™s awfully quiet in these here pages ...โ€ ๐ŸŒต๐Ÿค 


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