NBME 21 Enterococcus faecalis (NBME Answers)

Retired NBME 21 Answers

nbme21/Block 2/Question#48 (reveal difficulty score)
A 75-year-old man has fever, back pain, and ...
Enterococcus faecalis 🔍 / 📺 / 🌳 / 📖
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submitted by felxordigitorum(12)

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Question asked for gram positive cocci in CHAINS. S. aureus forms clusters, eliminating it. This leaves Enterococcus faecalis and Group A strep. E. faecalis is associated with UTIs.

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almondbreeze get the clinicals but got thrown off by 'chain'. FA2019 pg.137 also says coccus = berry, strepto =twisted (chain), differentiating the two:( +2

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submitted by ∗sinforslide(63)

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It seems like Staph aureus UTI's are almost exclusively nosocomial, esp. w/ patients with urinary catheters: "We identified and entered into the study 102 consecutive patients for whom at least 1 urine culture was positive for S. aureus...82% had a urinary catheter of some type in place"

Here's the link to the study

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submitted by aishu007(4)

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can anyone explain why enterococcusfaecalis is the answer here?

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priapism Best I can guess is that both S. aureus and E. faecalis can cause UTI, but S. aureus is described as having clusters where as the other Gm+ cocci are in chains +8

nala_ula My doubt here in this question is the fact that Enterococcus faecalis is a normal gut microorganism that causes these different symptoms of sickness after genitoruinary or gastrointestinal procedures... but in this question there is no mention of any procedures. +

fez_karim its says chains, so not staph. only other is entero +

temmy according to first aid, staph aureus is not one of the high yield bugs for UTIs +1

temmy uti bugs are E.Coli Staph saprophyticus Klebsiella pneumonia Serratia Marcescens Enterococcus Proteus mirabilis Pseudomonad aeruginosa +

privatejoker Where in FA 2019 does it list that C.coccus is specifically in chains? +

privatejoker E.Coccus* i mean +

divya @privatejoker FA 2018 Pg 134 table +

jennybones @privatejoker Enterococcus is Group-D STREP. Streps are arranged in chains. +2

santal FA 2019 Page 639, too. +

backwardsprogress Enteroccocus is also a pretty common cause of chronic prostatitis, which was the give away in the prompt if you didnt know the characteristics of entero: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3715713/ +

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submitted by ∗mangotango(27)

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Seems like he has pyelonephritis because of the systemic symptoms (e.g. fever). The most common causes of that are E. coli (90%) followed by Enterococcus faecalis and Klebsiella. The only one that fits under "gram positive chains" is Enterococcus faecalis. // Pathoma pg. 132

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