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NBME 20 Answers

nbme20/Block 3/Question#35 (46.2 difficulty score)
A 51-year-old man has the acute onset of ...
Cytomegalovirus infection🔍,📺
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 +37 
submitted by amorah(100),
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everF t;-&g lure uto lfte ratrelcvniu riaelfu ST MP-MX rpslhipxyoa -;t&g rlue uto toyecmPsuins ecvidynirKjoe i lnptsnatra but on R/CWCBB in ruine gt;&- ruel uto saartnltpn torcejeni

Lavgein VMC dan apaclyti mcatmcoiruybe as eth mnneraigi two t.ioosnp VCM is moer ilykle ni a lnstrptnaa etint.pa




 +4 
submitted by hayayah(1100),
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MCV si casidaoste whit eciinftng ornag atnarptsnl stp.inaet VMC si ttdtisernam avi sexula ntoctc,a gonar ttn,raanspl or elryitcval iva .nleatcpa Rncvtitaieao fo MVC sccuor ni eht .mssdueremopuisnp

anrOg raatntnlsp ptseinat aer ta na ercidsnae isrk fo MVC oneuapn.mi




 +1 
submitted by lifeisruff(1),

he was never given ganciclovir - i used that as a clue over transplant rejection




 +0 
submitted by mrglass(41),
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yhW wluod tshi otn eb cutae apnnatsltr cjoneietr degnail to DA?SR Teh tinaercnie is aeevldte, dna I see ayn oersan yhw ti lwudo be ealedvet noyebd ojnrceiet

sammyj98  I selected the same. I think part of the question wanted us to recognize that the pt was not receiving CMV prophylaxis (hinted that they are getting TMP-SMX but no Gancyclovir) so they're at really high risk for CMV specifically. UpToDate: •Universal prophylaxis with valganciclovir or ganciclovir is typically given to patients at risk for cytomegalovirus (CMV) reactivation (eg, seropositive recipients and those with seropositive donors). The duration of therapy often depends on the type of organ transplanted, the risk status of the patient, and individual institutional practice. Some transplant centers prefer to use a pre-emptive approach (eg, routine CMV viral load monitoring within initiation of treatment when reactivation becomes evident) for specific patient populations. (See 'Cytomegalovirus' above.) +  
utap2001  I was also confused by acute rejection. CMV cannot be completely D/D with rejection. But the drug used is hint. The stem says they used cyclosporine, prednisone. That should rule out rejection. +  

via @sammyj98 via UpToDate:

Universal prophylaxis with valganciclovir or ganciclovir is typically given to patients at risk for cytomegalovirus (CMV) reactivation (eg, seropositive recipients and those with seropositive donors). The duration of therapy often depends on the type of organ transplanted, the risk status of the patient, and individual institutional practice. Some transplant centers prefer to use a pre-emptive approach (eg, routine CMV viral load monitoring within initiation of treatment when reactivation becomes evident) for specific patient populations.

+3/- drdoom(957),