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NBME 21 Answers

nbme21/Block 1/Question#38 (20.8 difficulty score)
A 47-year-old woman with aplastic anemia is ...
Amphotericin B🔍

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leRu of rsttuthmchou/b

  • ooseinNsur afulng cosenn:tiif taetr wtih _oaoclnze
  • uSirose faulng snnotiifec (ge, midrmoucspmeiomno tasnptei ihwt isneemadtdis einotc:inf) reatt iwth tocaehrpimin B

iiAdatlodn foni

  • eTh anmi scalsse of glanutainf ondamiceist orf mesul iuldc:ne
  • ePsoeynl ge(, hiitmpncoera B, sinytna)t - Bdin to etrgorleso sclmleeuo ni alngfu ecll aes,emnrmb anteigrc repso adn siugnac lcel lyiss
  • iTlzeraso e,g( zonae_c)lo - neterPv hte ytisshesn fo orroelt,gse a tmpennooc fo lgfnua lcle smmneeabr
  • icdaocnsEnnih e(g, gn,panfocsui )munacifnig - nbIitih the nitheysss fo u,nalcg a dslpchoaraeiyc ontcpeomn of gaufnl elcl wlsla
  • riienmPidys ,(ge e)ulcoFtsiny - dCeovetnr ot lol-fur5cr,iau icwhh thne ihiitbns lngufa NAR dna oprnite yntiseshs
jcmed  Cell Membrane = Amphotericin & Nystatin Cell WALL = Capsofungin To not mix them up I say to myself "IT's the FUNGIN CELL WALL" +1  

Terbinafine/Tolnaftate - inhibit squalene epoxidase/sterol biosynthesis. Squalene builds interfere with fungal membrane function and cell wall synthesis.

+1/- h0odtime(42),

 +5  upvote downvote
submitted by hungrybox(791),
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My pioesinrms of chiAemrnoitp B is taht t'is het BIG UGNS. It hgasitrt pu ttaacsk the rstseol in the giunf alsapm ar.menmeb

Melnwhiea lil bihct sdrgu kiel lzao-se utsj biniith lotrse inshetsys. (itbaerin-efn X lsnlt,eraoo lzso-ea X lorge)toesr

uFgnins X llec wlal sehitsny,s lneisyofctu X niecclu diac esnsh.tsyi

et-tu-bromocriptine  Rule of thumb/shortcut: Nonserious fungal infections: treat with _conazole Serious fungal infection (eg, immunocompromised patients with disseminated infection): treat with amphotericin B Additional info The main classes of antifungal medications for usmle include: Polyenes (eg, amphotericin B, nystatin) - Bind to ergosterol molecules in fungal cell membranes, creating pores and causing cell lysis Triazoles (eg, _conazole) - Prevent the synthesis of ergosterol, a component of fungal cell membranes Echinocandins (eg, capsofungin, micafungin) - Inhibit the synthesis of glucan, a polysaccharide component of fungal cell walls Pyrimidines (eg, Flucytosine) - Converted to 5-fluoruracil, which then inhibits fungal RNA and protein synthesis +2  
et-tu-bromocriptine  Ripppp the formatting, but hopefully the idea gets across +  
et-tu-bromocriptine  Fixed it, see comment! +