NBME 24 Monosodium urate (NBME Answers)

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Retired NBME 24 Answers

nbme24/Block 2/Question#27 (reveal difficulty score)
A 47-year-old man comes to the physician ...
Monosodium urate 🔍 / 📺 / 🌳 / 📖
tags: repeat rheum

+8 upvote downvote
submitted by ∗neonem(629)

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These are gout crystals. I suppose the best way to differentiate this case from pseudogout is that the crystals are sharp & needle-shaped and not rhomboid-shaped.

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sympathetikey Yep. They tried to throw you off with the picture, but the wording in the stem says its a "photomicrograph" -- not exposed to plane polarized light, where you would see the negative birefringence. +19

linwanrun1357 Why is NBME so mean to us. Do those mean a lot in clinic？ +

suckitnbme @linwanrun1357 I highly doubt you would be looking at your own joint fluid aspirates instead of sending it to the lab. +3

nnp what those yellow white nodules signify? +

peqmd In clinic gout is typically a clinical diagnosis. If you can treat w/ NSAIDs instead of aspirate you would do that. You would aspirate if you are considering septic arthritis so you can get culture. I don't think anyone aspirate for heck of it. +

lowyield @nnp, the yellow white nodules are tophus which is a sign of chronic gout, characterized histologically by aggregates of uric acid crystals, can show up as skin nodules most commonly on external ear, olecranon bursa or achilles tendon (pg 467 FA 2020) +

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submitted by ∗abhishek021196(119)

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Calcium Pyrophosphate [Pseudogout] Crystals are rhomboid and weakly ⊕ birefringent under polarized light (blue when parallel to light).

Gout [Monosodium urate] Crystals are needle shaped and ⊝ birefringent under polarized light (yellow under parallel light, blue under perpendicular light

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jj375 https://i.pinimg.com/originals/f3/4f/e8/f34fe895aaa93a554469bf6a51cba428.jpg +

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submitted by ∗mtkilimanjaro(18)

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Also to note: Uric acid KIDNEY STONES are rhomboid not needle shaped. I was dumb and thought gout crystals in synovial fluid were rhomboid and forgot about needle shape :(

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