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NBME 21 Answers

nbme21/Block 3/Question#5 (47.8 difficulty score)
A 70-year-old woman is found to have ...
Candida albicans 🔍

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aCniadd si a atpr fo het olanmr laofr fo knis, lucod aeusc taoinoatmninc of a nlacetr oevuns tah.terce eTh insotuqe ststae tath het aomnrgsi si r,elppu ,dnubidg did not onesdpr ot oabrd rtcuesmp atsinobctii aka( tehy ddn'ti sue eolzlfuacno or iemtciphrnoa )B. alL,sty hyte dheswo it ldtepa no bdool raag dan ehetr was on yoshesmil which iteinmlase hapst (het lnyo roeth ibospsle ecnrdoetn

psocroCtyccu yuasull elsinvov tngiseniim in dcnommoipmseiruom .stp E. iloc is mrga psroaigeventiotr xh si yausull andrmeittst yb a thrno on a rose or oeeosmn thwi a tsioryh of ridnggnae

hungrybox  Also, the yeast form of Candida is gram (+) +30  
dr_jan_itor  I got thrown off by the part where they said "ovoid" and thought they were implying a cigar shape. I chose sporothrix for the morphology in spite of knowing that it clincally made no sense. +1  
lilmonkey  I chose S. aureus before reading the question (looks like b-hemolysis). Then I saw "budding organisms" and picked the correct one. +  
the_enigma28  I think, elliptical budding yeast forms kind of excluded cryptococcus since its almost round -_- +  
the_enigma28  I think, elliptical budding yeast forms kind of excluded cryptococcus since its almost round -_- +  
lowyield  cryptococcus also doesn't take up gram stain because the shell is too thiqq +2  

submitted by paperbackwriter(113),

In addition to the more obvious hint of budding organism, candida has fuzzy edges on blood agar which the others don't.

usmlehulk  @paperbackwriter cryptococcus have a narrow budding. +  
lovebug  wow I Didn't know that. THX~! +  

submitted by liuvictor428(1),

Apparently, it is a common pitfall to mistake Candida albicans for Staph spps or vice versa in blood agar.

I think this explains well. Check this out:

"Culture: Candida albicans grows well on Sabouraud dextrose agar and most routinely used bacteriological media. Cream colored pasty colonies usually appear after 24-48 hours incubation at 25-37°C. The colonies have a distinctive yeast smell and the budding cells can be easily seen by direct microscopy in stained or unstained preparations.

In Blood Agar, Candida albicans gives white, creamy colored colonies which can be mistaken for Staphylococcus spp. Whenever you are analyzing the culture report of ‘high vaginal swab’, take extra care as the colony you are observing can be of Candida albicans instead of Staphylococcus aureus or vice versa (quick solution for this is to perform wet mount or gram staining and observing under microscope)."

I guess this question can be tricky. It is a trap if we just go for the culture picture, which I did. So I got it wrong. lol