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NBME 23 Answers

nbme23/Block 3/Question#48

A 20-year-old woman comes to the physician because ...

Inhibition of the cytochrome P450-dependent demethylation reaction

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 +21  upvote downvote
submitted by yotsubato(537),

So for Candida we can use

Azoles (fluconazole) (inhibit CYP450 demethylation)

Amphotercin B (pore formation in fungal cell membrane)

Caspofungin (prevent crosslinking of beta glucans in cell wall)

or Nysatin for oral or esophageal cases (pore formation)

This question is saying that she is taking an ORAL drug to treat candida vaginitis.

Amphotercin is IV

Caspofungin is also IV

so we're left with azoles

Azoles inhibit synthesis of ergosterol by inhibiting CYP 450 that converts lanosterol to ergosterol.

qball  Nystatin does treat vaginal candidiasis but is TOPICAL. +  
thotcandy  Nystatin is NOT for esophageal candidiasis, Swish and spit, not swallow. +1  
staghorn  Me - picks Metronidazole -_- +  
alexxxx30  @thotcandy...actually you can swish and swallow nystatin for esophageal infections (per Sketchy micro candida sketch) +1  
turtlepenlight  I have seen that on the wards so I hope it works! +  
fexx  and my smartass picks amphp B +  

 +2  upvote downvote
submitted by jrod77(21),

Azoles inhibit cytochrome P450 enzyme that converts lanosterol to ergosterol.

this is the best treatment indicated for candida.

 +0  upvote downvote
submitted by dai89(0),

isn't candida yeast form under body temperature? why the picture shows a mold form?

danielautran  Maybe because the picture wasn't taken from inside the body +1