Nbme 3 spoiler alert!!!!!!!

[RedSoxSuck]

1. Which of the following contaminants will be removed from a fluid passed through 0.45 micro filter?

a. HSV
b. HIV protease
c. LPS
d. Mycoplasma hominis
e. Staph A

Answer key says: E

Have no clue.

2. A 59-year-old man comes to the emergency department because of fever and shaking chills for 24 hours. He completed a course of fluorouracil for a neoplasm 1 week ago. His temperature is 39°C (102.2°F), and blood pressure is 85/60 mm Hg. Physical examination shows no other abnormalities. His hematocrit is 30%, leukocyte count is 400/mm3, and platelet count is 100,000/mm3. Which of the following agents will most specifically complement antibiotic therapy in this patient?

A. Erythropoietin
B. Granulocyte colony-stimulating factor
C. Interleukin-1 (IL-1)
D. IL-2
E. Leucovorin

Answer key says B but i chose D. I was not 100% clear on to why its B over D.

3. An 8-year-old boy is brought to the physician by his parents because of episodes of shortness of breath, nonproductive cough, and wheezing that last 5 to 10 minutes and occur more frequently during the winter. The incidence and severity of these episodes is most likely to be decreased by selective inhibition of which of the following enzymes?

A. Cyclooxygenase-1
B. Cyclooxygenase-2
C. Epoxygenase
D. 5-Lipoxygenase
E. Phospholipase A1
F. Thromboxane synthase

Answer is D according to the key. What makes this a better answer than lets say E? D is more specific?

4. A 61-year-old woman with a long history of poorly controlled hypertension suddenly has excruciating anterior upper sternal pain radiating to the neck and back. On admission to the emergency department, her blood pressure is 210/110 mm Hg. Fifteen minutes later, while lying down, it is 110/64 mm Hg. Transesophageal echocardiography shows aortic insufficiency, a suggestion of a double lumen of the ascending aorta, and a pericardial effusion. She dies suddenly while awaiting an operation. Which of the following is the most likely cause of death?

A. Acute hemopericardium
B. Acute myocardial infarct
C. Cerebral infarct
D. Congestive heart failure
E. Massive retroperitoneal hemorrhage

Answer is A. Why couldn't it be E or why A is better than A? I do understand that hemopericardium can lead to tamponade which is the most common cause of death in aortic dissection.

5.A 49-year-old man comes to the physician because of fatigue, lightheadedness on standing or sitting up rapidly, and dark-colored stools for the past 4 days. He moved to the USA from southeastern Asia 2 years ago. His history includes chronic hepatitis B infection. Examination shows pale mucous membranes, an enlarged liver, a prominent periumbilical venous pattern, and nonbleeding internal hemorrhoids. Hemoglobin concentration is 7.8 g/dL. Upper endoscopy shows circumferentially prominent tortuous veins with an adherent clot at the gastroesophageal junction. Which of the following mechanisms best explains the blood loss in this patient?

A. Acute inflammation of the gastroesophageal mucosa
B. Arteriovenous fistulae at the gastroesophageal junction
C. Hepatic artery obstruction with increased celiac pressure
D. Increased flow through collateral hepatic veins
E. Increased pressure in submucosal esophageal veins

I chose b.

6. A 34-year-old African American man comes to the physician because of muscle aches and reddish brown urine for 12 hours. He began treatment with trimethoprim-sulfamethoxazole 1 day ago for otitis media. He is allergic to penicillin. A sample of blood after centrifugation shows red serum. A deficiency of which of the following enzymes is the most likely cause of these adverse effects?

A) Acetyltransferase
B) Glucose-6-phosphate dehydrogenase
C) γ-Glutamyl transpeptidase
D) Glutathione reductase
E) 1α-Hydroxylase

Answer is B. I chose D because i figured if you don't have Glutathione reductase then it doesn't matter whether you are able to produce NADPH or not. So B is correct because its a better answer and more likely than D? Stupid me...

7. A 22-year-old woman comes to the physician because of abdominal cramping and bloody diarrhea for 24 hours. She works as a kindergarten teacher, and several of the children at her school have had a gastrointestinal illness in the past week. She takes no medications. Physical examination shows increased bowel sounds. Which of the following is the most likely causal organism?

A. Bacillus anthracis
B. Bacillus subtilis
C. Clostridium difficile
D. Clostridium perfringens
E. Listeria monocytogenes
F. Salmonella typhi
G. Shigella flexneri

Key says G.

8. An 80-year-old woman dies shortly after admission to the hospital because of a 3-day history of progressively increasing shortness of breath. She had a history of heart failure. Examination of the lungs during autopsy shows alveolar damage with distended lymphatics, congested alveolar capillaries, and pink-staining homogenous proteinaceous hyaline material in alveoli. Which of the following is the most likely cause of these findings?

A. Amyloidosis
B. Aspiration pneumonitis
C. Emphysema
D. Pneumonia
E. Pulmonary edema
F. Septic shock

I chose A but the key says E. I guess i was distracted by homogenous proteinceous hyaline material ( Diabetes or chronic HTN). Thoughts..

9. A 14-year-old girl is admitted to the hospital because of palpitations, an irregular pulse, migratory polyarthritis, and a low-grade fever. She had acute tonsillitis 3 weeks ago. Assays for antistreptococcal antibodies and C-reactive proteins are positive. Her 10-day stay in the hospital is uneventful, and her ECG changes have resolved. Prophylactic antistreptococcal therapy is used for prevention of which of the following long-term sequelae?

A. Aschoff bodies
B. Fibrinous pericarditis
C. Mitral valve stenosis
D. Polyarthritis
E. Sydenham chorea

key says Its c. I chose A well because its seen in RF. What makes C a better answer if its correct?

10. A 32-year-old nulligravid woman comes to the physician because she has not been able to conceive for 2 years. She has a 3-year history of pelvic pain and dyspareunia. Pelvic examination shows enlargement of the left adnexa and nodularity of the cul-de-sac. Laparoscopy shows dark areas 3 to 5 mm in diameter throughout the cul-de-sac. The left adnexa are covered by adhesions and cannot be visualized. A biopsy specimen of the cul-de-sac lesion is most likely to show which of the following?

A. Adenocarcinoma
B. Endometrial glands and stroma
C. Epithelial inclusion cysts
D. Granuloma
E. Mesothelial tumor

Answer is: B. Why couldn't it be A?

11. After eating, a 40-year-old woman has a vague feeling of discomfort in the right upper quadrant of the abdomen. Ultrasonography discloses several small calculi, believed to be cholesterol gallstones, in the gallbladder. She begins oral therapy with ursodeoxycholic acid. Which of the following is the best rationale for this treatment?

A. Addition of bilirubin to the bile
B. Decrease in the concentration of bile acids
C. Decrease in the ratio of cholesterol to bile acids
D. Increase in the ability of the gallbladder to concentrate bile
E. Increase in the concentration of lecithin in bile

I chose C but the key says B. Internet search has revealed for C and B as answer choices.

12. In a clinical study, 100 subjects are examined for a particular genetic alteration hypothesized to be related to prostate cancer. The results are shown in the table.

Genotype Number of Controls
AA 30
AB 25
BB 45

If A is one allele, and B is the other, which of the following is the frequency of the B allele?

A. 25/200
B. 45/200
C. 50/200
D. 90/200
E. 115/200

Okay, this is a stupid question. Meaning i should know this. For some reason i am stuck. Can anyone dumb it down for me? Key says answer is E.

13. A 15-year-old girl is brought to the physician for a well-child examination. She is upset because her right breast is larger than the left, and she will not attend physical education classes because she is embarrassed to undress. Breast development began 2 years ago. Menarche has not yet occurred. Examination shows the right breast to be twice as large as the left; the right breast is Tanner stage 4, and the left breast is Tanner stage 3. Which of the following is the most appropriate intervention?

A. Reassurance
B. Psychological evaluation
C. Estrogen therapy
D. Progesterone therapy
E. Operative treatment

How is the answer reassurance? I thought there is soemthing clearly wrong with her because menarche normally occurs at age 13 and since it hasn't yet means there is something wrong. I am not sure.


Thanks guys. Greatly appreciate it.

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[Kaputt]

1. Which of the following contaminants will be removed from a fluid passed through 0.45 micro filter?

a. HSV
b. HIV protease
c. LPS
d. Mycoplasma hominis
e. Staph A

Answer key says: E

Have no clue.

Goofy question, but basically it's asking which of the answer choices is physically the biggest and wouldn't fit through the filter. Staph A > Mycoplasma > HSV > HIV protease > LPS

2. A 59-year-old man comes to the emergency department because of fever and shaking chills for 24 hours. He completed a course of fluorouracil for a neoplasm 1 week ago. His temperature is 39°C (102.2°F), and blood pressure is 85/60 mm Hg. Physical examination shows no other abnormalities. His hematocrit is 30%, leukocyte count is 400/mm3, and platelet count is 100,000/mm3. Which of the following agents will most specifically complement antibiotic therapy in this patient?

A. Erythropoietin
B. Granulocyte colony-stimulating factor
C. Interleukin-1 (IL-1)
D. IL-2
E. Leucovorin

Answer key says B but i chose D. I was not 100% clear on to why its B over D.

The problem is that 5-FU made the patient neutropenic. G-CSF helps the neutrophil lineage develop to churn out more cells. IL-2 is a T cell cytokine, and not important in this situation cause we need neutrophil workhorses right now, not those lazy lymphocytes that take forever to do anything.

I'm too lazy to look at the rest

 

[Phloston]

Kaputt did #1+2, so I'll do #3+4. Other people should help do the rest.

3. An 8-year-old boy is brought to the physician by his parents because of episodes of shortness of breath, nonproductive cough, and wheezing that last 5 to 10 minutes and occur more frequently during the winter. The incidence and severity of these episodes is most likely to be decreased by selective inhibition of which of the following enzymes?

A. Cyclooxygenase-1
B. Cyclooxygenase-2
C. Epoxygenase
D. 5-Lipoxygenase
E. Phospholipase A1
F. Thromboxane synthase

Answer is D according to the key. What makes this a better answer than lets say E? D is more specific?

This is the same thing as with why aspirin can exacerbate asthma. When you knock out COX, the lipoxygenase pathway is unopposed (remember that there is not a shunting of substrates; the pathway is merely unopposed, so if you were to see an arrow-question involving this mechanism, leukotrienes are "--" and PGs are "down"). This means LTC/D/E4 are unopposed, and they induce bronchoconstriction. Phospholipase A1 is too non-specific. You've gotta know that -lukast drugs are good to use in aspirin-induced asthma alongside your albuterol.

4. A 61-year-old woman with a long history of poorly controlled hypertension suddenly has excruciating anterior upper sternal pain radiating to the neck and back. On admission to the emergency department, her blood pressure is 210/110 mm Hg. Fifteen minutes later, while lying down, it is 110/64 mm Hg. Transesophageal echocardiography shows aortic insufficiency, a suggestion of a double lumen of the ascending aorta, and a pericardial effusion. She dies suddenly while awaiting an operation. Which of the following is the most likely cause of death?

A. Acute hemopericardium
B. Acute myocardial infarct
C. Cerebral infarct
D. Congestive heart failure
E. Massive retroperitoneal hemorrhage

Answer is A. Why couldn't it be E or why A is better than A? I do understand that hemopericardium can lead to tamponade which is the most common cause of death in aortic dissection.

I had encountered this in probably GT QBank that, as you said, the most common cause of death in aortic dissection is cardiac tamponade, not choice E. Acute aortic insufficiency means that the dissection has stretched proximally to the aortic valve, so a haemopericardium is likely.

 

[Ronin786]

Kaputt did #1+2, so I'll do #3+4. Other people should help do the rest.




This is the same thing as with why aspirin can exacerbate asthma. When you knock out COX, the lipoxygenase pathway is unopposed (remember that there is not a shunting of substrates; the pathway is merely unopposed, so if you were to see an arrow-question involving this mechanism, leukotrienes are "--" and PGs are "down"). This means LTC/D/E4 are unopposed, and they induce bronchoconstriction. Phospholipase A1 is too non-specific. You've gotta know that -lukast drugs are good to use in aspirin-induced asthma alongside your albuterol.



I had encountered this in probably GT QBank that, as you said, the most common cause of death in aortic dissection is cardiac tamponade, not choice E. Acute aortic insufficiency means that the dissection has stretched proximally to the aortic valve, so a haemopericardium is likely.

Adding onto the hemipericardium answer, the fact that on lying down her BP went down means that the blood is compressing her heart and is another hint to tamponade being the cause of death.

I'll post the rest in another post.

 

[Ronin786]

5.A 49-year-old man comes to the physician because of fatigue, lightheadedness on standing or sitting up rapidly, and dark-colored stools for the past 4 days. He moved to the USA from southeastern Asia 2 years ago. His history includes chronic hepatitis B infection. Examination shows pale mucous membranes, an enlarged liver, a prominent periumbilical venous pattern, and nonbleeding internal hemorrhoids. Hemoglobin concentration is 7.8 g/dL. Upper endoscopy shows circumferentially prominent tortuous veins with an adherent clot at the gastroesophageal junction. Which of the following mechanisms best explains the blood loss in this patient?

A. Acute inflammation of the gastroesophageal mucosa
B. Arteriovenous fistulae at the gastroesophageal junction
C. Hepatic artery obstruction with increased celiac pressure
D. Increased flow through collateral hepatic veins
E. Increased pressure in submucosal esophageal veins

I chose b.

His liver cirrhosis means that he's going to have esophageal varices, which is due to E. increased pressure in submucosal esophageal veins. AVM fistuals are usually congenital and the portal HTN presentation is more likely to mean an esophageal varices thats bleeding on and off (based on the clot found on endoscopy) and thats causing his iron deficiency anemia

6. A 34-year-old African American man comes to the physician because of muscle aches and reddish brown urine for 12 hours. He began treatment with trimethoprim-sulfamethoxazole 1 day ago for otitis media. He is allergic to penicillin. A sample of blood after centrifugation shows red serum. A deficiency of which of the following enzymes is the most likely cause of these adverse effects?

A) Acetyltransferase
B) Glucose-6-phosphate dehydrogenase
C) γ-Glutamyl transpeptidase
D) Glutathione reductase
E) 1α-Hydroxylase

Answer is B. I chose D because i figured if you don't have Glutathione reductase then it doesn't matter whether you are able to produce NADPH or not. So B is correct because its a better answer and more likely than D? Stupid me...

I'm not entirely sure why it would be G6PD over Glutathione Reductase, but G6PD is more common in blacks and this is classic presentation. It may have to do with Glutathione Reductase needing G6PD to function in the first place, or it may just be more common.

7. A 22-year-old woman comes to the physician because of abdominal cramping and bloody diarrhea for 24 hours. She works as a kindergarten teacher, and several of the children at her school have had a gastrointestinal illness in the past week. She takes no medications. Physical examination shows increased bowel sounds. Which of the following is the most likely causal organism?

A. Bacillus anthracis
B. Bacillus subtilis
C. Clostridium difficile
D. Clostridium perfringens
E. Listeria monocytogenes
F. Salmonella typhi
G. Shigella flexneri

Key says G.

Bloody diarrhea means Dysentery and the only one of those that causes dysentery is Shigella. Salmonella cause typhoid fever (rose spots), Bacillus anthracis causes anthrax (worse than a transient GI, probably would have wiped out the class 😛), apparently subtilis is a normal flora of the gut, Clostridium difficile cause pseudomembranous collitis, but there is no mention of her taking any drugs (theres even an emphasis that shes not taking drugs), Perfringens causes gas gangrene and Listeria causes neonatal meningitis and is usually transmitted during birth.

8. An 80-year-old woman dies shortly after admission to the hospital because of a 3-day history of progressively increasing shortness of breath. She had a history of heart failure. Examination of the lungs during autopsy shows alveolar damage with distended lymphatics, congested alveolar capillaries, and pink-staining homogenous proteinaceous hyaline material in alveoli. Which of the following is the most likely cause of these findings?

A. Amyloidosis
B. Aspiration pneumonitis
C. Emphysema
D. Pneumonia
E. Pulmonary edema
F. Septic shock

I chose A but the key says E. I guess i was distracted by homogenous proteinceous hyaline material ( Diabetes or chronic HTN). Thoughts..

The hyaline material here is referring to ARDS. No fever or hints toward septic shock or pneumonia. And Heart Failure isn't predisposing towards Emphysema. I guess heart failure caused the pulmonary edema which in turn led to ARDS.

Also Amyloidosis wouldnt have such an acute case.

9. A 14-year-old girl is admitted to the hospital because of palpitations, an irregular pulse, migratory polyarthritis, and a low-grade fever. She had acute tonsillitis 3 weeks ago. Assays for antistreptococcal antibodies and C-reactive proteins are positive. Her 10-day stay in the hospital is uneventful, and her ECG changes have resolved. Prophylactic antistreptococcal therapy is used for prevention of which of the following long-term sequelae?

A. Aschoff bodies
B. Fibrinous pericarditis
C. Mitral valve stenosis
D. Polyarthritis
E. Sydenham chorea

key says Its c. I chose A well because its seen in RF. What makes C a better answer if its correct?

Ive seen a similar question in Rx, but it involved RF vs PSGN. Basically antibiotics are useful in preventing RF and not PSGN since PSGN is self limited anyways. In this case I guess Mitral Valve Stenosis is really the most dangerous and most long-term sequelae here.

10. A 32-year-old nulligravid woman comes to the physician because she has not been able to conceive for 2 years. She has a 3-year history of pelvic pain and dyspareunia. Pelvic examination shows enlargement of the left adnexa and nodularity of the cul-de-sac. Laparoscopy shows dark areas 3 to 5 mm in diameter throughout the cul-de-sac. The left adnexa are covered by adhesions and cannot be visualized. A biopsy specimen of the cul-de-sac lesion is most likely to show which of the following?

A. Adenocarcinoma
B. Endometrial glands and stroma
C. Epithelial inclusion cysts
D. Granuloma
E. Mesothelial tumor

Answer is: B. Why couldn't it be A?

The dark areas are most likely referring to chocolate cysts that are commonly seen in Endometriosis. Adenocarcinoma is going to be more common in post menopausal women.

11. After eating, a 40-year-old woman has a vague feeling of discomfort in the right upper quadrant of the abdomen. Ultrasonography discloses several small calculi, believed to be cholesterol gallstones, in the gallbladder. She begins oral therapy with ursodeoxycholic acid. Which of the following is the best rationale for this treatment?

A. Addition of bilirubin to the bile
B. Decrease in the concentration of bile acids
C. Decrease in the ratio of cholesterol to bile acids
D. Increase in the ability of the gallbladder to concentrate bile
E. Increase in the concentration of lecithin in bile

I chose C but the key says B. Internet search has revealed for C and B as answer choices.

I don't know about this one. Seeing as ursodeoxycholic is a bile acid it should decrease the ratio.

12. In a clinical study, 100 subjects are examined for a particular genetic alteration hypothesized to be related to prostate cancer. The results are shown in the table.

Genotype Number of Controls
AA 30
AB 25
BB 45

If A is one allele, and B is the other, which of the following is the frequency of the B allele?

A. 25/200
B. 45/200
C. 50/200
D. 90/200
E. 115/200

Okay, this is a stupid question. Meaning i should know this. For some reason i am stuck. Can anyone dumb it down for me? Key says answer is E.

Basically since there are 2 copies of the allele per person you have to multiply the number of people by 2. So there are 200 overall.
You can use Hardy Weinberg or not, but in essence BB means 2 alleles per person which is equal to 90 (45x2) and then the AB means 1 B allele per person which is going to be the normal 25 (or 50/2). 90 + 25 is 115.

13. A 15-year-old girl is brought to the physician for a well-child examination. She is upset because her right breast is larger than the left, and she will not attend physical education classes because she is embarrassed to undress. Breast development began 2 years ago. Menarche has not yet occurred. Examination shows the right breast to be twice as large as the left; the right breast is Tanner stage 4, and the left breast is Tanner stage 3. Which of the following is the most appropriate intervention?

A. Reassurance
B. Psychological evaluation
C. Estrogen therapy
D. Progesterone therapy
E. Operative treatment

How is the answer reassurance? I thought there is soemthing clearly wrong with her because menarche normally occurs at age 13 and since it hasn't yet means there is something wrong. I am not sure.

This is one of those stupid questions where you have to know that there is variance in puberty. For example if it was a male coming to you with gynaecomastia during puberty then that is also normal due to the hormone imbalance during puberty. Apparently the breast bud is actually a stage called Thelarche and it preceeds Menarche. Also Menarche can be normal to not occur until 15-16 years of age.

From my experience any questions involving puberty more than likely involving normal hormonal changes just because everything is out of whack. Thats obviously not true with a 5-alpha-reductase deficiency but thats been my experience.

 

[Phloston]

For question 6:

Firstly, sulfa drugs are listed in FA as causing haemolysis in G6PD deficiency, so this should have rung a bell without even needing to look at glutathione reductase.

G6PD deficiency is a common inherited disease, particularly in blacks.

G6PD is the rate-limiting step in the reaction, not glutathione reductase. This means Vmax would be lowered more greatly by the former's deficiency vs the latter.

 

[Ronin786]

I had a question about Number 2 but I think I reasoned it out. How would GCSF increase his hematocrit which is down to 30%? I initially assumed the answer would be leucovorin, but that would be with MTX since 5FU doesn't cause a folate deficiency.

Basically if the drug in the question was MTX would the correct response be Leucovorin? And does GCSF have any effect on HCT?

 

[Kaputt]

I had a question about Number 2 but I think I reasoned it out. How would GCSF increase his hematocrit which is down to 30%? I initially assumed the answer would be leucovorin, but that would be with MTX since 5FU doesn't cause a folate deficiency.

Basically if the drug in the question was MTX would the correct response be Leucovorin? And does GCSF have any effect on HCT?

GCSF won't help the hematocrit as far as I know. It will only help replenish the granulocyte lineage, which is what is needed to "complement" the antibiotics.

 

[RedSoxSuck]

Adding onto the hemipericardium answer, the fact that on lying down her BP went down means that the blood is compressing her heart and is another hint to tamponade being the cause of death.

I'll post the rest in another post.

Yea, i just couldn't translate "acute hemipericardium"👎

 

[RedSoxSuck]

His liver cirrhosis means that he's going to have esophageal varices, which is due to E. increased pressure in submucosal esophageal veins. AVM fistuals are usually congenital and the portal HTN presentation is more likely to mean an esophageal varices thats bleeding on and off (based on the clot found on endoscopy) and thats causing his iron deficiency anemia


I'm not entirely sure why it would be G6PD over Glutathione Reductase, but G6PD is more common in blacks and this is classic presentation. It may have to do with Glutathione Reductase needing G6PD to function in the first place, or it may just be more common.


Bloody diarrhea means Dysentery and the only one of those that causes dysentery is Shigella. Salmonella cause typhoid fever (rose spots), Bacillus anthracis causes anthrax (worse than a transient GI, probably would have wiped out the class 😛), apparently subtilis is a normal flora of the gut, Clostridium difficile cause pseudomembranous collitis, but there is no mention of her taking any drugs (theres even an emphasis that shes not taking drugs), Perfringens causes gas gangrene and Listeria causes neonatal meningitis and is usually transmitted during birth.



The hyaline material here is referring to ARDS. No fever or hints toward septic shock or pneumonia. And Heart Failure isn't predisposing towards Emphysema. I guess heart failure caused the pulmonary edema which in turn led to ARDS.

Also Amyloidosis wouldnt have such an acute case.


Ive seen a similar question in Rx, but it involved RF vs PSGN. Basically antibiotics are useful in preventing RF and not PSGN since PSGN is self limited anyways. In this case I guess Mitral Valve Stenosis is really the most dangerous and most long-term sequelae here.


The dark areas are most likely referring to chocolate cysts that are commonly seen in Endometriosis. Adenocarcinoma is going to be more common in post menopausal women.


I don't know about this one. Seeing as ursodeoxycholic is a bile acid it should decrease the ratio.


Basically since there are 2 copies of the allele per person you have to multiply the number of people by 2. So there are 200 overall.
You can use Hardy Weinberg or not, but in essence BB means 2 alleles per person which is equal to 90 (45x2) and then the AB means 1 B allele per person which is going to be the normal 25 (or 50/2). 90 + 25 is 115.

This is one of those stupid questions where you have to know that there is variance in puberty. For example if it was a male coming to you with gynaecomastia during puberty then that is also normal due to the hormone imbalance during puberty. Apparently the breast bud is actually a stage called Thelarche and it preceeds Menarche. Also Menarche can be normal to not occur until 15-16 years of age.

From my experience any questions involving puberty more than likely involving normal hormonal changes just because everything is out of whack. Thats obviously not true with a 5-alpha-reductase deficiency but thats been my experience.

7. Doesn't salmonella also causes bloody diarrhea? Or is it because shigella is more likely to be the causative agent than salmonella. Unless question would have mentioned something about chicken etc?

 

[RedSoxSuck]

Ive seen a similar question in Rx, but it involved RF vs PSGN. Basically antibiotics are useful in preventing RF and not PSGN since PSGN is self limited anyways. In this case I guess Mitral Valve Stenosis is really the most dangerous and most long-term sequelae here.

Pathoma says: MS is usually due to chronic rheumatic valve disease and Rapid review (page 178) says the same thing. It does make sense because Ashoff bodies are seen with granuloma and strep has nothing to with formation of granuloma. So better answer is mitral stenosis.

 

[Ronin786]

Pathoma says: MS is usually due to chronic rheumatic valve disease and Rapid review (page 178) says the same thing. It does make sense because Ashoff bodies are seen with granuloma and strep has nothing to with formation of granuloma. So better answer is mitral stenosis.

Aschoff nodules are a sequelae or Rheumatic Fever which is caused by Group A B-Hemolytic Strep (after pharyngitis).

Aschoff Nodules and Anitschkow cells are the myocarditis portion of RF. However, Mitral Stenosis is the more severe side effect and I guess more long term. Antibiotics would prevent both of them if I'm not mistaken, since they prevent the molecular mimicry from taking place.

I think the difference here is which one is more severe and is the feared complication and that is Mitral/Valvular disease

 

[RedSoxSuck]

Aschoff nodules are a sequelae or Rheumatic Fever which is caused by Group A B-Hemolytic Strep (after pharyngitis).

Aschoff Nodules and Anitschkow cells are the myocarditis portion of RF. However, Mitral Stenosis is the more severe side effect and I guess more long term. Antibiotics would prevent both of them if I'm not mistaken, since they prevent the molecular mimicry from taking place.

I think the difference here is which one is more severe and is the feared complication and that is Mitral/Valvular disease

Thanks. Much appreciated!