Kim! Hi! Itโ€™s your dad!๐Ÿ‘‹ ▪ Khalilah, Iโ€™m proud of you for taking a risk for your dream.Everyoneโ€™s explanations tend to be so on-point, and the commiseration makes me feel better, too!Hi Hira. You are doing a good job!Hey Shariq! Doing a great job!                       want to add a fly-by? email us! ๐Ÿ˜Š
share email twitter ⋅ join discord whatsapp(2ck)
Free 120  NBME 24  NBME 23  NBME 22  NBME 21  NBME 20  NBME 19  NBME 18  NBME 17  NBME 16  NBME 15  NBME 13 
search for anything NEW!
NBME 18 Answers

nbme18/Block 2/Question#17 (reveal difficulty score)
65 yo woman, 1 week of swollen, painful knee
Uric acid๐Ÿ”,๐Ÿ“บ
tags:

Login to comment/vote.


Tutor box

Members from the Leaderboard offering 1-on-1 help: Want to be listed here? Email us!

 +0 
submitted by i-de-liver(2),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

osDe aoneyn knwo why sthi si rUic idcA not .N roaonehrg? lAl I ese ni teh agiprochmr era nripouhl.est sI that twhie ilne ni the didlem fo het creutip atth vareysol het hyecypmlot ppsodues to be eht s-hnedleapdee iurc dc?ia Or si ti ucabees eh'ss na dlo aydl adn uulylas cisept tisihrAtr si omfr .S ,ruuAse so it ldouw rmeo lkei by uirc cadi nad tno hgoanrroe incse sseh' e?rdol

maverick95  I struggled between those two answer choices as well. I thought that the large needle shape right in the middle was a uric acid crystal which helped push me towards Uric Acid as my answer. I also took into account that she was older (even though STIs are rampant among the elderly) she didn't really seem to have any other symptoms or history of STI/gonorrhea. I figured with her age that she just wasn't able to excrete Uric Acid enough, and got a gout. Something a pathologist told me one time was that they put the focus of the picture in the middle of the shot. So considering the uric acid-looking shape was right in the middle, I figured that's what they wanted us to focus on with the picture. Hope this helps. +15  
i-de-liver  Ah gotcha! I guess I shouldn't have thought that the thing in the middle was an artifact lol... thank you!! +2  
a1913  I believe it's because: 1) there is nothing given that would be risk factors for this woman to have N. gonorrhea 2) The thing in the middle is indeed an MSU crystal, just not under polarized light 3) apparently we get acute inflammation and increase in WBCs with crystal-induced arthropathies, per Table 11-2 on page 8 here (10 page document, top of page of interest will say p. 260) --> http://downloads.lww.com/wolterskluwer_vitalstream_com/sample-content/9781582558752_Mundt/samples/Chapter_11.pdf Also take a look at the pics on the previous page, left column for an example. I got this wrong as well, but I definitely won't again! lol +4  
cr  i had the same problem, Whats about the fever?, could be present in gout? +1  
rainlad  I think this question mentioned the patient's temp was 100.4 which is consistent with mild fever in gout from inflammation. This photo was wack though +  
t123  The damage in gout is mediated by Neutrophils, so makes complete sense you see a bunch. +4  
stunna216  actually STI's arent that rampant in the elderly, more common to get E. coli infections +