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NBME 16 Answers

nbme16/Block 4/Question#32 (reveal difficulty score)
A 70-year-old woman is found to have ...
Candida albicans ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +7  upvote downvote
submitted by โˆ—bingcentipede(356)
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Ugh this question. The Gram stain and purple made me thing Staph aureus, but it also mentions "budding" and "elliptical" (SA is a coccus). Additionally, SA is not a common UTI infection while Candida is.

Annoying because of the Gram stain and purple descriptor.

From quora: "when decolourizer is added, the crystal violet taken up by yeast cells is retained." https://www.quora.com/Why-does-a-yeast-cell-give-Gram-positive-reaction

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melanoma  Also we can recognize Staph aureus for the beta hemolysis in a blood agar +1
fatboyslim  This isn't a UTI. She has a central venous catheter place (CVC), not a foley catheter. CVCs are a risk factor for candidemia. (At first glance I also thought she had a urinary catheter placed, it's important for us to not incorrectly skim over pertinent details :D) +1



 +6  upvote downvote
submitted by โˆ—feliperamirez(45)
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Indwelling IV catheters is a common cause of disseminated candidiasis and it is due to adherence of the yeast to the catheters.

Remember that disseminated infection may also result in patients with neutropenia

CMI dysfunction (AIDS, SCID) predisposes to mucocutaneous NOT disseminated infections

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