NBME 24 Epstein-Barr virus-induced brain lymphoma (NBME Answers)

Retired NBME 24 Answers

nbme24/Block 3/Question#22 (reveal difficulty score)
A 32-year-old woman recently diagnosed with ...
Epstein-Barr virus-induced brain lymphoma 🔍 / 📺 / 🌳 / 📖
tags: neuro repeat AIDS

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submitted by ∗lsmarshall(465)

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I thought this was a trick question since skin cancers are the most common type of cancers overall. But actually among HIV patients, HIV-related cancers are much more common than non-HIV-related cancers (even skin cancers). EBV-induced primary CNS lymphoma is the only option that is AIDs-defining illness/cancer.

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medskool123 why not hep B? i guess another whats the better answer ones... Just rem reading that it was more common with aids pts.. anyone have an idea about this? +1

haliburton Yes, I think CNS lymphoma as an AIDS defining illness wins the day. My thought was since SHE has AIDS it is most likely from IVDA, which has a high risk of HBV that could go undiagnosed for a long time. at 32, that might not be long enough to have HBV and get HCC (but with no immune system...?) +3

yotsubato God damn this is such BULLSHIT... +15

trichotillomaniac Why you gotta do me dirty like this NBME +2

sars My thought process, usually wrong all the time, was that HBV (IVDU) can occur to anyone. Acute hepatitis to Chronic occurs when HBV incorporates its DNA into host and releases mutagenic proteins. This is regardless of immunosuppresion. Primary CNS Lymphoma reappears primarily when you are immunosuppressed (organ transplant, immunodeficiency, HIV/AIDS). +2

syoung07 Hep C is far more likely to become HCC than hep B +2

jurrutia Even if you were thinking skin cancer is more common, that's only true for basal cell and squamous. Melanoma is rare. EBV much more likely in aids patient. Even H pylori was a better answer. +

Lymphoma in patients with AIDS can take on many forms, but primary CNS lymphoma is common.
It often presents with seizures, lethargy, subacute memory loss, and headache. Physical examination may show neurologic deficits stemming from structural disruption caused by the location of the mass.
MRI will usually show a dominant cortical mass.

DDX * Multiple lesions distributed throughout the cortex would be atypical! --> HSV enceph or Toxo

+/- namesthegame22(14)

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submitted by ∗krewfoo99(115)

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EBV virus infections B cells. As a response there is reactive lymphocytosis (proliferation of CD8+ cytotoxic T Lymphocytes). In HIV, you will have a decrease in TH cells leading to decrease in CD8 T cells. Thus EBV will proliferate more freely as the immune response towards it (CD8 cells) are blunted. This is how i got to the answer.

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