NBME 24 Lungs (NBME Answers)

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Retired NBME 24 Answers

nbme24/Block 1/Question#4 (reveal difficulty score)
A 28-year-old man with AIDS has fever, ...
Lungs 🔍 / 📺 / 🌳 / 📖
tags: micro cryptococcus

+13 upvote downvote
submitted by ∗welpdedelp(270)

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Cryptococcal meningitis that is transferred through respiratory droplets

https://www.cdc.gov/fungal/global/cryptococcal-meningitis.html

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+0 upvote downvote
submitted by ∗thesmexynevus(1)

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I completely blanked out on the "mucicarmine stained" buzzword, but managed to somehow get it right by thinking which was the most common route (among the options) that would lead to meningitis.

An eye, middle ear, or skin infection doesn't commonly lead to meningitis.

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-8 upvote downvote
submitted by ∗seagull(1933)

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https://en.wikipedia.org/wiki/Blastomycosis#/media/File:Blastomyces_dermatitidis_GMS.jpeg

I believe this is actually disseminated Blastomyces due to the "Broad Based Budding" as seen in the picture.

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seagull However, given the stain and some of the features I now see that this is most likely Crypto. THey like similar. my bad +17

mjmejora oh what a catch! I also thought this was Blasto until you explained otherwise +2

drmohandes Blasto = broad-based budding, the two 'circles' look equal in size. Crypto = narrow-based -unequal- budding. +8

paperbackwriter ^ I would disagree a little bit. "Broad based" and "narrow based" refer to how smushed the circles are. So narrow based is when the membrane bit they're sharing is small, and broad based is when they share a lot of membrane. So if just pinching off --> crypto, if they look stuck/have a flat membrane between them --> blasto +4

jbrito718 I was also struck by the similar presentation to Blasto even though mucicarmine points straight to Cryptococcus. regardless, both are primary in lungs so I was safe picking that answer +1

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