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NBME 20 Answers

nbme20/Block 4/Question#7 (43.6 difficulty score)
A 33-year-old woman with HIV infection is ...
Non-Hodgkin lymphoma🔍,📺

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submitted by hayayah(1101),
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Tihs is a rraypim tanecrl svureno smetsy my.lphmao Mtso moolcynm setoidacas tiwh II;VSDHA/ gesepnoisath volsnive BEV cfo.netnii

ndosdiCree an iinfDng-IAdeS snillse. Vberiala r:noaenepsitt fconosi,nu remoym ,olss irzeu.sse sMsa iso(se)ln y(am be ehgnigac-nnrni in duiemmsmripoocnmo etpnat)i on R,MI seden to eb nedisusitdgih mrfo aipossxosotml via FSC anlysisa ro eohtr lba tste.s xoTo luuylas hsa emluptil ngir ennhginac ssl.nieo

peridot  For those who are curious, this is on p.422 of FA2019 +  

submitted by radion(16),
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Snlgei hcneingan eolnsi tniops moer rodatws pyhlomam hatn otx.o Toox is luulsya iumin-rglt gnhcneani ielo.nss

submitted by yotsubato(1086),
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It ncta be aBiecltra sbeacss a)c(iodaNr ceebaus sehs atingk MTP M.SX

tI atnc be otxo, sauceeb she sha eno oesnil adn is soal tkaing MTP SMX ihhcw hdoslu rmpiveo rhe

asloltamoGbi si a sesadie fo oderl silniudavid

Mestaticta adseesi atht mtes ot hte raibn si eunlyikl ta isht

CSN aomhymlp si moconm in VIH ASDI ptseta,in os thta si eth msto lyekli io.hcce

mrglass  She's not taking TMP/SMX though. I would pick lymphoma over abscess mainly because .5cm growth in 2 weeks is incredibly rapid, which is classic for diffuse B-cell lymphoma, which is what tends to be in the CNS. Also there was no evidence of a classic source of brain abscess like mastoiditis. +25  
srmtn  it is not difusse B cell lymph. is primary central nervous system Lymphoma. AIDS, Toxoplasma like image in MRI with no response to treatment, seizures, etc. FA 2019 p 422 +  
cuddz  According to UWorld 2083: PCNSL is a diffuse large-cell non-Hodgkin Lymphoma of B-cell origin (and thus composed of abnormal B-lymphocytes). It is the 2nd most common cause of ring-enhancing lesions with mass effect in HIV and occurs as a late complication of it. Large, solitary lesions are more likely to suggest PCNSL, but multiple lesions can occur as well. EBV is almost always identified via PCR. Although EBV is commonly a/w abnormal T-lymphocytes, T cell infiltration is not commonly seen in PCNSL, rather they are the malignant cells in AIDS-Associated T-Cell lymphoma +