NBME 21 Formation of destructive free radicals (NBME Answers)

NBME 21 Answers ↦

nbme21/Block 4/Question#29 (33.5 difficulty score)
A 22-year-old man comes to the physician ...
Formation of destructive free radicals🔍
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+8
submitted by humble_station(68),

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ihsT si a preutci of iGdiara a…bimlla decusa by rkinndig amtninaecdot tware hwit sy.cst

neattcduulieMl titohposorze

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qball This is testing our knowledge in a FAIR way. Why cant there be more questions like this instead of them trying to trick us, have poorly worded questions or have us pick the least shitty answer. End of rant. +1

+2
submitted by vlodkadrinker(7),

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doianizlte rrpdereef ued to ensgil sdeo

sweetmed or metronidazole +

niboonsh what would his diagnosis be tho? +

lostweightthxnorovirus @niboonsh Giardia I believe. the trophozoite is pictured in the problem and has a classic "shield-like" appearance. FA 2019 pg. 155 has more information and the sketchy for it was really good! +1

nwinkelmann Per FA, DOC for giardia = metronidazole. MOA of metronidazole = formation of toxic free radical metabolites in the bacterial cell wall that damage DNA making it bactericidal and antiprotozoal. Metro treats = GET GAP = giardia, entamoeba, trichomonas, Gardnerella, anaerobes (below diaphragm), and H. pylori (as an alternative to amoxicillin in PCN allergy). Adverse effects = disulfiram-like reaction, HA, and metallic taste. I didn't know what Tinidazole is, and found out it is of the same drug class as Metronidazole, so makes sense why it would also be used for Giardia. For the purpose of the UMSLE 1, though, I think metronidazole would be DOC (especially because tinidazole isn't in FA). +9

mannywillsee This little bug has has a face, and now you can't unsee it either! +

-1
submitted by the_enigma28(45),

Is there any drug which would cause enhancement of cell membrane permeability to chloride? It seems like the MOA of ETEC & V. cholerae adenylate cyclase toxins and somewhat that of Ivacaftor used in cystic fibrosis.

kevin For the purposes of STEP 1 I don't think there is an antibiotic that would do that. If you wanted to really stretch the definition of enhanced cell permeability you could go with a polymixin which is essentially a detergent for bacterial membranes and can be used rarely for pseudomonas and other bacteria +