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USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


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Old 09-06-2014
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Default GOUT tretment

Hi, I read this question and everyone seems to be answering Indomethacin (NSAID) while I think the treatment should be Steroids as Celecoxib is an NSAID which already failed to treat this patient, so why try another NSAID?!

52 yo man with excruciating pain and swelling of jis r toe since appendectomy 10 days ago. pain is sever cannot tolerate his bedsheets touching the toe. Rx with celecoxib was useless. temp-99.6, examination-toe is swollen erythematous,marked tenderness of metatarsopharyngeal joint. next app step?

1) acetaminophen
2) ALLOPUrinol
3)aspirin
4)dexamethasone
5) Indomethacin

Can someone please explain why
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Old 09-06-2014
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Quote:
Originally Posted by spasemaster View Post
Hi, I read this question and everyone seems to be answering Indomethacin (NSAID) while I think the treatment should be Steroids as Celecoxib is an NSAID which already failed to treat this patient, so why try another NSAID?!

52 yo man with excruciating pain and swelling of jis r toe since appendectomy 10 days ago. pain is sever cannot tolerate his bedsheets touching the toe. Rx with celecoxib was useless. temp-99.6, examination-toe is swollen erythematous,marked tenderness of metatarsopharyngeal joint. next app step?

1) acetaminophen
2) ALLOPUrinol
3)aspirin
4)dexamethasone
5) Indomethacin

Can someone please explain why
hey...well i will go for intraarticular Dexamethasone injection...as in case of NSAID failure or Renal failure, the patient should be given steroids...
In case of intra-articular steroid failure the patient can be given colchicine.

Source : MTB 2
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Old 09-06-2014
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Quote:
Originally Posted by MDdoc88 View Post
hey...well i will go for intraarticular Dexamethasone injection...as in case of NSAID failure or Renal failure, the patient should be given steroids...
In case of intra-articular steroid failure the patient can be given colchicine.

Source : MTB 2


Well, on MTB it actually says that it Steroids can be used in case of NSAIDs failure in which case this patient did fail with "celexoib"
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Old 09-06-2014
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and they can also be used in case of multi join affection for treatment which means (I think) that it can be used either oral or IV, not just intra-thecal.
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Old 09-06-2014
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Originally Posted by spasemaster View Post
and they can also be used in case of multi join affection for treatment which means (I think) that it can be used either oral or IV, not just intra-thecal.
dont use it intra thecally....inject it to the joint affected !!!!!!! and in case of multiple joints start orally !!!!!!!!
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Old 09-06-2014
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Quote:
Originally Posted by MDdoc88 View Post
dont use it intra thecally....inject it to the joint affected !!!!!!! and in case of multiple joints start orally !!!!!!!!
sorry meant to say intra-articular
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