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NBME 21 Answers

nbme21/Block 1/Question#15

A 35-year-old man comes to the physician because of ...

Increased vascular permeability

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 +4  upvote downvote
submitted by neonem(372),

This is a case of acute gout. Monosodium urate crystals are taken up by neutrophils, leading to an acute inflammatory reaction. T-cells aren't really involved in gout (more rheumatoid arthritis).

hungrybox  Great explanation! So frustrating that I got this wrong, should have been easy. +2  
temmy  the way i thought about it was how did the neutrophils get there? the answer is via increased vascular permeability +9  
nor16  they, unfortunately, did not ask " how did neutrophils get there" but " whats the cause of the swelling " not to confuse with " what causes the swelling " +1  
divya  absolutely right temmy. that's how i thought about it too. +  

 +0  upvote downvote
submitted by sweetmed(83),

The chemotactic factors produced by monocytes and mast cells and the local vasodilatation stimulates neutrophilic chemotaxis. Also, endothelial cells activation further aggravates the inflammatory response and migration of neutrophils. This leads to an influx of neutrophils locally.

refrence: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5512152/

bronchophony  Why not complement activation? +  
joyceeepan  the way i though about it was: you need antibodies (IgG/IgM) to activate the complement system. But there's no such a thing as an anti-gout antibody. (and it is not an infection neither) +1