Step 2 UWorld Self-Assessment (UWSA) 2 Practice Exam

Colchicine is favored for an acute gout flare when heart failure and recent drug-eluting stent placement are in play because it relieves inflammation without the fluid-retaining, kidney-impairing, or bleeding risks tied to NSAIDs in congestive heart failure and while on dual antiplatelet therapy. Colchicine works by inhibiting neutrophil chemotaxis and inflammasome-driven inflammation, which dampens the acute joint attack without affecting platelet function. NSAIDs are avoided here because they can worsen heart failure course by causing sodium and water retention and reduce renal perfusion, plus they raise GI bleeding risk when a patient is on antiplatelet therapy after stent placement. Corticosteroids can be used if NSAIDs are unsuitable, but they carry risks like fluid retention and hyperglycemia that may complicate heart failure. Allopurinol is aimed at long-term urate lowering and isn’t used to treat an acute flare, since starting urate-lowering therapy during an attack can prolong symptoms.