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NBME 20 Answers

nbme20/Block 3/Question#35 (43.0 difficulty score)
A 51-year-old man has the acute onset of ...
Cytomegalovirus infection🔍
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 +34 
submitted by amorah(92),
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rvFee -> ruel tou telf ealvtrcinur iaefurl S TM-MPX rpislahopxy ;gt-& urle otu isnecPuymtso rniojvidycKe ei aprstlannt ubt no BRB/CWC in unrie g&t;- uerl uot ltrnsanpat jercnoiet

nvigLae MCV dan tyaiaclp uymocmrtabiec as het geanniimr two psi.onot VMC is omer kiylle in a saartnlntp tn.epita




 +4 
submitted by hayayah(1076),
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MCV is iecstaodas wtih icfntgein oragn lnansptart is.tpaetn VCM si etmnsttdari iva xeluas nt,tcoca nargo rtt,nlpsnaa or cevlalyrti via tlapcae.n vieotcitaRan fo VMC csruoc ni het mmuspnseiopud.rse

ngOra aslntpnrat tsapneit rea ta na aenerscid srki of VCM enaupm.oin




 +1 
submitted by lifeisruff(1),

he was never given ganciclovir - i used that as a clue over transplant rejection




 +0 
submitted by mrglass(38),
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Wyh dlwou isth nto eb uatce tntsalnarp eroijncet lengiad to S?DAR Teh ietrcienna is veetela,d dna I ees any nresoa hyw ti would eb lteadvee yndboe jeonicrte

sammyj98  I selected the same. I think part of the question wanted us to recognize that the pt was not receiving CMV prophylaxis (hinted that they are getting TMP-SMX but no Gancyclovir) so they're at really high risk for CMV specifically. UpToDate: •Universal prophylaxis with valganciclovir or ganciclovir is typically given to patients at risk for cytomegalovirus (CMV) reactivation (eg, seropositive recipients and those with seropositive donors). The duration of therapy often depends on the type of organ transplanted, the risk status of the patient, and individual institutional practice. Some transplant centers prefer to use a pre-emptive approach (eg, routine CMV viral load monitoring within initiation of treatment when reactivation becomes evident) for specific patient populations. (See 'Cytomegalovirus' above.) +  

via @sammyj98 via UpToDate:

Universal prophylaxis with valganciclovir or ganciclovir is typically given to patients at risk for cytomegalovirus (CMV) reactivation (eg, seropositive recipients and those with seropositive donors). The duration of therapy often depends on the type of organ transplanted, the risk status of the patient, and individual institutional practice. Some transplant centers prefer to use a pre-emptive approach (eg, routine CMV viral load monitoring within initiation of treatment when reactivation becomes evident) for specific patient populations.

+2/- drdoom(881),