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NBME 18 Answers

nbme18/Block 3/Question#45 (reveal difficulty score)
A 34 yo man 3 month history of progressive ...
Antineoplastic ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

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 +19  upvote downvote
submitted by โˆ—apurva(101)
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THIS IS KAPOSI's SARCOMA ==> give antineoplastic


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michaelshain2  It's unfortunate that I had to pay in order to get these answer explanations. They aren't as informative/thorough on freenbme :/ +6
jamaicabliz  So annoyed, I thought it was asking us to recognize that it could also be Bacillary Angiomatosis from Bartonella, which also presents in the immunocompromised... So any different study materials stress the importance of differentiating them, given they look very similar. +2
drdoom  @apurva tell that to my loan officer!๐Ÿ˜๐Ÿ˜‚๐Ÿ˜‚ +
cbreland  Between this and bacillary angiomatosis, I think it came down to Kaposi being more likely with a HIV patient and also the lesions being purple +
jsanmiguel415  It says that "in addition to treatment with highly active antiretroviral therapy" which makes me think this is HHV-8 -> Kaposi sarcoma. Bartonella is bacterial and would be treated with azithro + doxy +
ih8payingfordis  The reason why this isn't Bacillary Angiomatosis is because the stem states that the rash is NOT painful. In BA, the rash is painful! +2

 +3  upvote downvote
submitted by โˆ—chediakhigashi(4)
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Another thing to think about is Kaposi typically presents in HIV pts earlier, under a 500 CD4 tcell count, while bartonella angiomatosis presents <100. This patient was recently diagnosed. Kaposi is "A malignant spindle cell tumor caused by the human herpesvirus 8 that originates from endothelial cells"-amboss, give antineoplasic. We arent given anything on neutrophilic/lymphocytic infiltrates... so I assume this is more just straight up identifying- FA 2019 pg 469.

lIkE iF YeUr frM OhIO, ColLecTIng staTs N sTufF

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 +2  upvote downvote
submitted by โˆ—an1(114)
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Kaposi Sarcoma --> up regulation of VEGF --> treat with an anti-VEGF eg. bevacizumab (anti-neoplastic)

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 +0  upvote downvote
submitted by โˆ—motherhen(69)
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Are these gottron's papules from dermatomyositis? Pareaneoplastic syndrome from adenocarcinoma, esp ovarian?

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j44n  it is not. The pt has a history of being immunocompromised. Also, gottron's are over the hands and dermatomysitis can present with a rash over the eyelid as well! There is also no history muscle weakness at the proximal muscles (shoudler/ hip area) and no mention of an elevated creatine kinase! - hope this helps :) +2

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