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Retired NBME 23 Answers

nbme23/Block 1/Question#21 (reveal difficulty score)
A 40-year-old woman with a history of ...
Bacterial pneumonia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: rituximab cd_markers

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 +22  upvote downvote
submitted by โˆ—thomasalterman(181)
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She just completed the course of rituximab, which targets CD20 receptors. B-cell deficiency can predispose to bacterial infections.

b) BM failure is not associated with rituximab c) wrong d) wrong e) this occurs w/in 7-10 days of starting treatment, and would not occur after completing a 4-month course of rituximab.

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meningitis  Forgot the time frame for Serum sickness and got it wrong.. thanks @thomasalterman +25
stinkysulfaeggs  Same. Crap. +2
medstudent22  Taking it one step further - B-cell depletion = decreased Ab secretion = decreased opsonization. Opsonization with subsequent phagocytosis by spleen = #1 mechanism by which encapsulated bacteria (ie Strep Pneumo) are degraded. +3



 +2  upvote downvote
submitted by โˆ—abhishek021196(119)
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Rituximab

Mechanism = Monoclonal antibody against CD20, which is found on most B-cell neoplasms.

Use = B-cell Non-Hodgkin lymphoma, CLL, ITP, rheumatoid arthritis, TTP, AIHA, MS.

Adv effects = Increased risk of progressive multifocal leukoencephalopathy in patients with JC virus.

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tyrionwill  low IgG in response to infection/vaccination leads to broad bacteria and virus infection or reactivation. bacteria: strep pneumonia, Hib virus: JC, HBV, CMV... +



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