NBME Answers : raspberryslushy's page

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submitted by lfsuarez(160), visit this page

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When patients are given Nicotinic acid(Niacin) they are told to expect common side effects to occur such as warmth and redness. One can avoid these side effects by taking aspirin

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mcl To expand on this, the flushing/warmth/redness is due to release of PGD2 and PGE2 which is why taking an NSAID helps. +20

snripper Doesn't acetaminophen inhibits COX 1-2, too? Why can't you use that instead of aspirin? Just wondering. +4

raspberryslushy I had this same question too, and had it narrowed down to those two choices. Ended up going w/aspirin but it was sort of a coin toss. Still not sure why it's not acetaminophen. +

eagleeeee I think the reason is that acetaminophen is inhibited peripherally and is mainly used to inhibit COX in the CNS +8

whatup The worst side effect of Niacin is hepatotoxicity. Acetaminophen is famously known for hepatoxicity so aspirin is a better answer +4

doctordave Acetominophen is an antipyretic and analgesic, but it is not antiinflammatory, so it wouldn't be useful for Niacin induced flushing. (See sketchy pharm for NSAIDs) +3

meja2 Acetiminophen mainly inhibits COX-2, thus would lead to inhibition of production of Leukotrienes, and more prostaglandins will be made from arachidonic acid only getting up by COX-1 [ I remember this by using its name, Ace-two-minophen for COX-2] +

fatboyslim Maybe aspirin is chosen over acetaminophen because aspirin irreversibly inhibits COX +

submitted by catch-22(98), visit this page

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I woud do a retrospective cohort here. I don't think this question is correct and provides too little information to get the correct answer. "Time efficient" is the operant word here but they simply didn't consider that retrospective cohort would be a better design here as long as the variables are coded.

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sherry I agree. I was hesitating between the two choices. I still think cohort study is better regarding the "risk". I hope this kind of questions wont pop out on the real thing. +3

soph I think key here was they were measuring risk though +1

yex I also chose cohort, since it is comparing a given exposure. +2

raspberryslushy I was also thinking retrospective cohort study - just as time efficient, can look at risk, and the Q stem said the cancer was common, and I think of case-control for rare conditions. It's like they forgot a cohort study could be retrospective. +2

boostcap23 The classic example they always give for why not to do retrospective cohort is because patients who have whatever disease your testing for are more likely to remember all their risk factor exposures than a normal person that doesn't have any disease. Of course in this case I'm sure the people running the study would be the ones who figure out how much arsenic was in the water but this also would be very time consuming to figure out for each individual person in the study. Thus a case-control study where you look at a group of people with >50 arsenic exposure and a group <5 arsenic exposure and simply see who has cancer and who doesn't would be easier and take less time. +2

hunter_dr According to the B&B and UWORLD, if question stem measures the exposure first, then it have to be a cohort study and you will do relative risk calculation, which is why i picked that as an answer. However, I do see 'Cases' and 'Control' both in the questions so maybe it is case-control study.. Bottom line is----WASTED MY $60 +