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Retired NBME 16 Answers

nbme16/Block 2/Question#4 (reveal difficulty score)
A 26-month-old boy is brought to the ...
Nocardia asteroides ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—the_enigma28(69)
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This seems like NADPH oxidase deficiency, as the patient has history of multiple cutaneous abscess with Staph aurues during past 9 months. Therefore, a catalase positive organism is the likely cause, besides microbiological characteristics befitting Nocardia

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cheesetouch  FA18 p 117 chronic granulomatous disease (NADPH oxidase deficiency), FA18 p139 Nocardia +



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submitted by โˆ—cassdawg(1781)
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Nocardia is a gram(+), weakly acid-fast bacteria that forms long, branching filaments resembling fungi. (FA2020 p139). Nocardia commonly causes pulmonary infection in the immunocompromised.

For the other answers: Fungi would not be gram (+) so you could eliminate Candida. Pneumocystis is "dented ping pong balls" and not filamentous on bronchoscopy. StreptoCOCCUS is a gram(+) coccus, not a rod. Bacillus anthracis is a gram(+), spore-forming rod that can have "medusa-head" halo of projections but his history does not have an exposure that would point to pulmonary anthrax (wool-sorters disease) and further it would still not be described as filamentous. Pulmonary anthrax also would likely have widened mediastinum on CXR.

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