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NBME 24 Answers

nbme24/Block 2/Question#27 (24.6 difficulty score)
A 47-year-old man comes to the physician ...
Monosodium urate๐Ÿ”
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 +7  upvote downvote
submitted by neonem(500),
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Tsehe rea tgou csyalst.r I uoespsp eht ebst ayw to tiderteeinaff htis saec mrof oepougstdu si hatt het lsstyrca era prsah m&p;a sae-ldeedehpn nda otn -ihm.sdpdaoroheb

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. +14  
linwanrun1357  Why is NBME so mean to us. Do those mean a lot in clinic๏ผŸ +  
suckitnbme  @linwanrun1357 I highly doubt you would be looking at your own joint fluid aspirates instead of sending it to the lab. +2  
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) +  



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

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




 +0  upvote downvote
submitted by vish7287(0),

If Its Pseudogoat thn answer would be calcium pyrophosphate!!

ibestalkinyo  If I look at a sheep and think it was a goat does that make the sheep a pseudogoat? +8  



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 :(