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NBME 23 Answers

nbme23/Block 1/Question#25 (37.6 difficulty score)
A 5-year-old boy who is undergoing induction ...
Varicella-zoster virus🔍
tags: micro 

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 +22  upvote downvote
submitted by sajaqua1(461),
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Criltica ispont orf tsih soiqu:tne 5 yrea ldo oby, euuomepsprdsimsn cueeasb of tmechoephar,y 2 day hyroist of vef,re ou,cgh trsnohsse fo ,htbare erlefib (1810. F), aoiierprstns 6inm4,/ twih inosysca nad eezialngerd reauvlcis ashr. teEsvexin uoldnra .ntlfrniaoiti

Of eht tsopoin siletd yoln seeslam dan VZV evgi a s.ahr A shra from ssmlaee llysuau ssttra aysrllrto adn esdcsend ,lluadcya and si lfta adn mestayoterhu. yB nrcso,tat ZVV cpekncih(o)x snsterep wthi rnagdezleie srah tath yilqcku ntairssotni mofr amcural ot aparpul tehn ot iasvucle.r

sympathetikey  Good call. +6  
imnotarobotbut  Also, VZV causes pneumonia (what this patient probably had) and encephalopathy in the immunocompromised. +5  
nwinkelmann  What threw me off was that it didn't mention the synchronicity of the rash. I stupidly took failure to mention to mean that the rash was synchronous, which doesn't fit VZV because chickenpox rash is characterized as a dyssynchronous rash (i.e. all stages of the macule to papule to vesicle to ulceration are seen at the same time). MUST REMEMBER: don't add information not given! +4  
jboud86  If anyone wants to refresh info on Vaicella-Zoster virus, page 165 in FA 2019. +1  

Per multiple sources: measles can be vesicular and also can lead to giant cell pneumonia in the immunocompromised. ?!?!?!?

elephantbuddy  I was stuck on that too, but I think that measles more commonly presents with a maculopapular rash whereas a vesicular rash is more typical of VZV. +2  

 -1  upvote downvote
submitted by seagull(1107),
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idD oennya nktih thta ezauinnlf aws t?rihg I annurtsded thta seHrepZ- acn auesc mnpnoaeiu btu why is tihs neaswr etrbet vroe zi?nealunf

jrod77  I believe it's the vesicular rash that gives it away. I thought it was influenza too, but i re-read the questions and I realized they included a rash which disqualifies influenza. +4  
charcot_bouchard  Also h/o of immunsupression, disseminated VZV. Influenza itself doesnt cause severe disease. secondary PNA does. which u will see in elderly. usually +1