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NBME 20 Answers

nbme20/Block 1/Question#7 (35.9 difficulty score)
A 5-year-old girl with AIDS develops a ...
Thymidine kinaseπŸ”

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submitted by hayayah(1057),
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vioA,clryc cliovrmc,aif lilacvvarocy are eiannsugo Thye dugroen rsvooennci to yracolvci hpaonemoohtsp via rivsu endoced iyn.-dehksamneiti allme,Uyitt yteh htibini ilarv DAN orpsleaeym yb anchi iaritetm.non

etMtdua liarv teiiymnhd sekain anc acesu irectessan.

len49  Foscarnet and Cidofovir on the other hand do not require phosphorylation by viral kinase, therefore should be used in strains that are shown to be resistant. +3  

submitted by andremosq(1),

this question is asking about mechanism of resistance of Acyclovir, famciclovir, valacyclovir. They are Monophosphorylated by HSV/VZV thymidine kinase. Clinical use: HSV and VZV. Mechanism of resistance: Mutated viral thymidine kinase

submitted by nafilnaf(1),

What does she have? My assumption was that she was getting NRTIs for HIV/AIDS which get phosphorylated by HOST thymidine kinases and the mechanism for viral resistance is mutations in reverse transcriptase

azibird  I think she has chickenpox, caused by varicella-zoster virus. From FA 2020 p 183: "Vesicular rash begins on trunk; spreads to face D and extremities with lesions of different stages" +3