NBME Form 3 Questions

[(nicedream)]

I don't have the exact ones, but if you took it, maybe you remember.

HIV pt. presented with confusion and mental status changes, died 2 days later. Image of an H & E stain of meninges. Looked like cryptococcus, only that is usually india ink stain. Cells/organism had big halos. Choices:

A. Candida
B. Cryptococcus
C. Mycobacterium-avium
D. Pneumocystis
E. Toxoplasma

Guys fingers got cyanotic on a cold night when he was walking his dog. Cause:

A. Decreased parasymp
B. Increased symp
C. Increased ADH
D. Decreased renin-angiotensin
E. Mast cell histamine release
F. Platelet serotonin release

I picked B for both. Got 590/238 so may have been right, but really have no idea. Anyone know?

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[(nicedream)]

Viremia is a feature of:

A. Bronchiolar infection with RSV
B. Herpes Zoster infection
C. Primary genital Herpes infection
D. Primary Varicella infection
E. Rhinovirus infection

B?

 

[closertofine]

Pretty sure you're right for the cold fingers one. You can even do a "sympathectomy" for Raynaud's syndrome to lessen the symptoms.

I think Varicella has viremia-- anyone sure?

 

[seansoutherland]

Pretty sure you're right for the cold fingers one. You can even do a "sympathectomy" for Raynaud's syndrome to lessen the symptoms.

I think Varicella has viremia-- anyone sure?

Varicella-Zoster virus: infects respiratory tract and spreads to the liver and skin via the BLOOD; an acute episode followed by latency in the sensory ganglia.

 

[(nicedream)]

Thanks guys

 

[Paws]

Well I have a question because CMMRS says that RSV is spread by viremia, p.175. "Think Viremia...the disemination of virions in the blood to distant sites....etc." it says for paramyxoviridae.

I put varicella but I am not so sure now. I thought this was a hard question - and a hard test.

 

[trudub]

Its not varicella in this instance because it says "PRIMARY INFECTION" the primary infection of varicella is in the lungs and does not involve viremia. Herpes zoster involves a transient viremia as particles move from the infected ganglia where they lie dormant to infect the skin. Many of the paramyxoviridae do have a viremic phase but RSV is usually not one of them. The primary infection from RSV is in the upper and lower respiratory tract with spread by syncytia formation. The answer I would think would thus be herpes zoster.

 

[(nicedream)]

Its not varicella in this instance because it says "PRIMARY INFECTION" the primary infection of varicella is in the lungs and does not involve viremia. Herpes zoster involves a transient viremia as particles move from the infected ganglia where they lie dormant to infect the skin. Many of the paramyxoviridae do have a viremic phase but RSV is usually not one of them. The primary infection from RSV is in the upper and lower respiratory tract with spread by syncytia formation. The answer I would think would thus be herpes zoster.

That's what I was thinking when I answered B.

 

[seansoutherland]

That's what I was thinking when I answered B.

Page 484 of "Medical Microbiology, 4th edition" (one of those thick textbooks with detailed explanations, unlike Step-Up or CMMRS:

Varicella-Zoster virus: causes chickenpox (varicella) and, with recurrence, causes herpes zoster, or shingles. (In other words, Herpes zoster is a manifestation of the secondary reactivation of Varicella.)

Pathogenesis and Immunity: PRIMARY VZV infection begins in the mucosa of the respiratory tract and then progresses via the bloodstream and lymphatic system to the cells of the reticuloendothelial system. A secondary viremia occurs after 11 to 13 days and spreads the virus throughout the body and to the skin....Fever and systemic symptoms occur with the rash.
The virus becomes latent in the dorsal root or cranial nerve ganglia AFTER the PRIMARY infection....On reactivation, the vrius replicates and is released along the neural pathways to the skin, causing a vesicular rash along the entire dermatome knowns as HERPES ZOSTER, OR SHINGLES.

Let me ask you this: How can reactivation of herpes (varicella) zoster, which travels via nerves, hop out of them into the blood and then decide to come back to the same dermatomal distribution?

(Word to your mom)

 

[(nicedream)]

Page 484 of "Medical Microbiology, 4th edition" (one of those thick textbooks with detailed explanations, unlike Step-Up or CMMRS:

Varicella-Zoster virus: causes chickenpox (varicella) and, with recurrence, causes herpes zoster, or shingles. (In other words, Herpes zoster is a manifestation of the secondary reactivation of Varicella.)

Pathogenesis and Immunity: PRIMARY VZV infection begins in the mucosa of the respiratory tract and then progresses via the bloodstream and lymphatic system to the cells of the reticuloendothelial system. A secondary viremia occurs after 11 to 13 days and spreads the virus throughout the body and to the skin....Fever and systemic symptoms occur with the rash.
The virus becomes latent in the dorsal root or cranial nerve ganglia AFTER the PRIMARY infection....On reactivation, the vrius replicates and is released along the neural pathways to the skin, causing a vesicular rash along the entire dermatome knowns as HERPES ZOSTER, OR SHINGLES.

Let me ask you this: How can reactivation of herpes (varicella) zoster, which travels via nerves, hop out of them into the blood and then decide to come back to the same dermatomal distribution?

(Word to your mom)

So it's Rhinovirus?

 

[Paws]

This is a hard question, and as we can see alot of us are still not sure of the answer. I have looked in Lippincotts as well and still am unsure, altho I agree it would not be zoster. Dang ....freakin' hard!

 

[1998]

So it's Rhinovirus?

I chose E as well.

 

[trudub]

From the journal of Pediatric Infectious Disease: "Herpes zoster (HZ) is usually associated with transient viremia caused by hematogenous spread of virus from the affected ganglion..."

 

[seansoutherland]

From the journal of Pediatric Infectious Disease: "Herpes zoster (HZ) is usually associated with transient viremia caused by hematogenous spread of virus from the affected ganglion..."

My point is that Herpes Zoster IS Varicella, but with the caveat that it encompasses the secondary reactivation along neural pathways. With that stated and all resources excluded, when I think of chicken pox, I think of fever and malaise, both symptoms of a reaction to systemic spread. Does anyone know if there are any systemic symptoms associated with shingles (Herpes Zoster)?

 

[seansoutherland]

My point is that Herpes Zoster IS Varicella, but with the caveat that it encompasses the secondary reactivation along neural pathways. With that stated and all resources excluded, when I think of chicken pox, I think of fever and malaise, both symptoms of a reaction to systemic spread. Does anyone know if there are any systemic symptoms associated with shingles (Herpes Zoster)?

Here's another thought: the question states viremia is a feature of:

--herpes zoster INFECTION
--primary varicella INFECTION

(two possible answers in question)

Here's another question: Does one get INFECTED by Herpes Zoster, knowing that Herpes Zoster is defined as the secondary reactivation of primary infection with Varicella?

I looked at some of the journals, and most indicate that viremia associated with Herpes Zoster occurs primarily due to immunocompromised patients, which would, of course be less common than Varicella infection in the scores of kids that get it every year.

Here's another thought: Varicella involves pustules all around the body, but primarily at the trunk. Herpes Zoster is distributed along the dermatome. When I think of viremia, I think "systemic" and thus pustules all around the body and not a single dermatome.

 

[Idiopathic]

That HIV question is crypto...sometimes its good to see the different stains on bugs that you only know one way.