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NBME 21 Answers

nbme21/Block 1/Question#14 (19.1 difficulty score)
A 21-year-old man is brought to the emergency ...
Streptococcus pneumoniaeπŸ”

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submitted by powerfulgarbage(13),

FA 2020, page 127:

Encapsulated bacteria are opsonized and then cleared by spleen. Asplenic patients have decreased opsonizing ability and an increased risk for severe infections.

They need vaccines to protect against Neisseria meningitidis, Streptococcus Pneumoniae, Haemophilus influenza

mnemonic: "No Spleen Here"

regardless I got this one wrong because of a 50/50 guess between strep and e. coli. I guess they wanted you to recognize that he was at risk for S. pneumonia sepsis and therefore needed to be vaccinated, whereas there's not much you can do to protect him from E. coli other than wash your hands lol

drdoom  ^ voted best username +  
mambaforstep  ^^what he/she said. FA 2019 pg 127 +  
meryen13  its not e coli not because you couldn't vaccinate the pt but because he was in an accident and the chances of infection with s. pneumo is higher. page 186 FA 2020: splenic pt: s.pneumo >> H. influenza b> N meningitidis +  

submitted by aesalmon(81),
unscramble the site ⋅ remove ads ⋅ become a member ($39/month)

teSnmyopelc = eomr uebltepssic to eneatslcapud orgmsnasi

I tup E. ilco as ist paldueetsnac but htta 'nstaw teh otsm hgrit sarnwe I ?usseg

pippylongstock  This question is asking about the β€˜S’ of FA Mnemonic for S. Pneumonia β€œMOPS”. Strep pneumo is the most common cause of sepsis in adults. +2  
emmy2k21  MOPS stands for meningitis, otitis, pneumonia, and SINUSITIS. It doesn't stand for sepsis. My guess as well is which is "more correct". It's about being able to identify encapsulated organisms and the spleen's role in immunity. Ha I chose E coli as well. +6  
et-tu-bromocriptine  emmy2k21 is correct, the S is for sinusitis. I was between E.coli & Strep Pneumo, but then recalled Sketchy putting the sickle on the 'encapsulated' knight in the Strep Pneumo video; Strep Pneumo is more associated with infecting sickle cell "functionally asplenic" patients. +3  
aneurysmclip  You could also recall that before splenectomy(ik this is a emergency splenectomy) we would want to give an encapsulated vaccine like the pneumococcal vaccine. this pushed me towards strep over ecoli +1  

submitted by drzed(206),

Perhaps this is an incorrect way of thinking about this, but I always associate the virulence of Strep pneumo to its capsule, but I only associate the K capsular antigen of E. coli to meningitis (recall that E. coli has other specific virulence factors like fimbriae for UTI).

So basically, I figured that the capsule of Strep pneumo is involved in more disease processes (MOPS) than the capsule of E. coli (mostly meningitis), and thus I chose Strep.

b1ackcoffee  You are right, this is INCORRECT way. Capsule helps in hematogenous spread by protecting from phagocytosis causing sepsis, meningitis, pneumonia, i.e. more systemic infections. +  

submitted by kevin(17),

Asplenic, think SHiN (Strep pneumo, Haemophilus, Neisseria). Do not bother with any other encapsulated organisms