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NBME 21 Answers

nbme21/Block 2/Question#48 (34.2 difficulty score)
A 75-year-old man has fever, back pain, and ...
Enterococcus faecalis🔍
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oQsuntei seakd for amrg vpsioiet cocic in AHN.CSI .S uerasu fsomr uslt,secr ealingtinim .it shiT leasve Etceoncucrso lecfasia dna ropGu A rst.ep E. calefasi si oadssaceit hwit s.TIU

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 aishu007(3),
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anc naeyon naliepx ywh lcsarusantccocioeeef si the nwsaer h?eer

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 +5  
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. +1  
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/ +  



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