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Retired NBME 22 Answers

nbme22/Block 4/Question#2 (reveal difficulty score)
Thirty minutes after taking 2 aspirin tablets ...
Acetaminophen ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +10  upvote downvote
submitted by generic_login(13)
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This is aspirin-intolerant asthma. Acetaminophen only inhibits COX within the CNS, so doesnโ€™t cause the leukotriene shunting that characterizes that disease.

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linwanrun1357  why not triptans? +5
joyceeepan  the girl has tension headache. Triptans is not a drug of choice. NSAID, Acetaminophen, (or TCA for prophylaxis) +3
vsn001  but question asks which drug she should take to /treat/ her headache? -> I fell into sumatriptan cause I know it didn't have prophylactic indications but more of a treatment. idk, was between the acetaminophen and sumatriptan, and would appreciate if someone can tell me why acetaminophen is the move for this patient. +2
texasdude4  for HA treatment you want to start off conservative anyway w/ Tylenol / NSAIDs before you move on to triptans. That and triptans are not used for tension HA +
jurrutia  Triptans are used for migraine headaches by causing trigeminal vasoconstriction. They are not analgesics. +



 +0  upvote downvote
submitted by โˆ—gainsgutsglory(38)
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Why is acetaminophen the correct answer other than process of elimination. NSAIDs can be used for tension HA and sheโ€™s too old for Reye Syndrome (i mean technically shes a child since shes <17, but not a classic picture at all). Iโ€™m confused.

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zelderonmorningstar  My reasoning was that aspirin and the other 3 are all NSAIDs, and she had an adverse reaction. Acetaminophen is not an NSAID, so she probably wonโ€™t have the reaction. +
gainsgutsglory  @zelderon But whatโ€™s the pathophys here? +
generic_login  This is aspirin-intolerant asthma. Acetaminophen only inhibits COX within the CNS, so doesn't cause the leukotriene shunting that characterizes that disease. +3
pfebo  Acetaminiphen is only antipyretic and analgesic. Does not have anti-inflammatory action like NSAIDs, so it is the most appropriate to treat a headache in a patient with aspirin-induced asthma. +
pfebo  Also, it is inactive peripherally so less probability of adverse effects +



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