NBME 20 Cytomegalovirus infection (NBME Answers)

NBME 20 Answers

nbme20/Block 3/Question#35 (reveal difficulty score)
A 51-year-old man has the acute onset of ...
Cytomegalovirus infection 🔍 / 📺 / 🌳 / 📖
tags: micro

+46 upvote downvote
submitted by ∗amorah(115)

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eeFvr &t;g- relu uot letf nreilcatvru uifelar T S-PMXM lsxypaophri -> rlue out ssnPicemyuot vyecej inrdoiKi pttnalnsra utb on BBCC/RW in reniu gt;&- eurl uto nsnatlaprt onerctjei

Lneavig CVM nda ptclyaia utacemboycmir as hte inignmear owt oponis.t VMC is omre yillke in a pnlasnttra pen.ttia

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+4 upvote downvote
submitted by ∗hayayah(1212)

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CVM is iaesscaodt iwth nceiingtf norga alspatrnnt e.ttpnasi MCV si emtrattsdin vai eulsax tt,ocnca argno anstal,pntr or icyletarlv via p.eltcnaa eitnoavaictR of MCV oscruc in hte emoresnupsp.sdimu

ganrO rattsaplnn ispaentt are ta na esndceair rksi of VCM emoau.npni

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+2 upvote downvote
submitted by ∗lifeisruff(3)

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eh swa vnere eving rclocnviaig - i dues taht as a cule oevr pnsaarnttl reciontje

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+1 upvote downvote
submitted by ∗mrglass(47)

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Why udwlo this ont be atuec atlaprnnst eejicnrto gdelian ot RADS? hTe reanniitec si leeevat,d dan I ees ayn esnrao why ti dwuol be letdveae edybon nojetecir

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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.) +1

utap2001 I was also confused by acute rejection. CMV cannot be completely D/D with rejection. But the drug used is hint. The stem says they used cyclosporine, prednisone. That should rule out rejection. +

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.

+5/- drdoom(1202)

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