nbme 16 block 3 46 que plz explain - rose033

[ArchivalUser]

http://i.imgur.com/MotFFfM.png

[ArchivalUser]

is d pic showing budding yeasts? wats d diagnosis?

[ArchivalUser]

CMV

[ArchivalUser]

i put ampho B and got it right

[ArchivalUser]

A? Not sure though...

Seemed like it's Fungi or Bacterial infection, but someone please explain

[ArchivalUser]

i think its a cryptococcal infection

[ArchivalUser]

Okay guys, lets discuss this question.

1) E is WRONG because Rituximab is a monoclonal IgG1 kappa antibody directed against the CD20 antigen and used to treat Low-grade or follicular CD20-positive non-Hodgkin's lymphoma.


2) D is WRONG because Infliximab is a chimeric IgG1κ monoclonal antibody specific for human tumor necrosis factor-alpha (TNFα. Its use for the treatment of psoriasis, Crohn's disease, ankylosing spondylitis, psoriatic arthritis, rheumatoid arthritis, and ulcerative colitis.

3) A is WRONG. If the DX is fungal pneumonia then the findings on CXR would show multiple pulmonary nodules. The case would mention about a Bronchoalveolar lavage revealing fungal species on fungal cultures.

4) Both A & B are WRONG. This patient's CXR shows Interstitial changes, with moderate pleural effusion. The finding on this patients CXR is inconsistent with bacterial or atypical pneumonia.

5) PAS stain looks like CMV.

6) During induction chemotherapy patients usually get prophylactic antibiotics, such as Bactrim, and Carbapenem.

My answer;

DX: CMV

TX: Ganciclovir

Lets see what the Official IDIOTS of NBME say about this one.


Best


Oncology

[ArchivalUser]

thank u guys. but I too kept A & got it correct , thought its histoplasma because in disseminated form chest xray shows difuse pulmonary infitrates(from UW) , plz correct me guys if im wrong

[ArchivalUser]

NBME Correct answer is A.

I think the reasoning would be Pneumonia is a major cause of death during induction chemotherapy for acute leukemias.

[ArchivalUser]

AmpB correct.