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NBME 23 Answers

nbme23/Block 1/Question#21 (42.2 difficulty score)
A 40-year-old woman with a history of ...
Bacterial pneumoniaπŸ”
tags: rituximab cd_markers 

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 +21 
submitted by thomasalterman(147),
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b) MB urleiaf is ton stcioedaas hwti i tcmbxira)u )dnr ogw eo )rnwg htsi rucsoc /niw 071- ysad fo griasttn ttereamtn, nad doluw not cruco eartf clitnmoepg a -hon4tm scoreu fo ix.mturbia

meningitis  Forgot the time frame for Serum sickness and got it wrong.. thanks @thomasalterman +20  
stinkysulfaeggs  Same. Crap. +2  
medstudent22  Taking it one step further - B-cell depletion = decreased Ab secretion = decreased opsonization. Opsonization with subsequent phagocytosis by spleen = #1 mechanism by which encapsulated bacteria (ie Strep Pneumo) are degraded. +1  



 +2 
submitted by abhishek021196(50),

Rituximab

Mechanism = Monoclonal antibody against CD20, which is found on most B-cell neoplasms.

Use = B-cell Non-Hodgkin lymphoma, CLL, ITP, rheumatoid arthritis, TTP, AIHA, MS.

Adv effects = Increased risk of progressive multifocal leukoencephalopathy in patients with JC virus.

tyrionwill  low IgG in response to infection/vaccination leads to broad bacteria and virus infection or reactivation. bacteria: strep pneumonia, Hib virus: JC, HBV, CMV... +