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NBME 24 Answers

nbme24/Block 1/Question#4 (35.4 difficulty score)
A 28-year-old man with AIDS has fever, ...
Lungs🔍,📺
tags: micro cryptococcus 

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 +12 
submitted by welpdedelp(242),
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cyCalocrcotp emiingnits tath is fesrrdntaer ohuhrtg arpioytserr tlropdes

ggblh/ocu/htctwnni../acwactpwv:yg.encamgst/io-lmpf/rlolcidlots




 -7 
submitted by seagull(1683),
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/gws./.hteFdd:tagw#pstcdpaneiyesMsiiki//so:met.imiBsia_rleat/iaGsiotjSeieml_iploom/Bkcdyr

I ebilvee sthi si ayltualc ditsmedinsea ascBstmeylo eud to het B"odar easBd Bun"dgid sa snee ni hte et.pruic

seagull  However, given the stain and some of the features I now see that this is most likely Crypto. THey like similar. my bad +16  
mjmejora  oh what a catch! I also thought this was Blasto until you explained otherwise +1  
drmohandes  Blasto = broad-based budding, the two 'circles' look equal in size. Crypto = narrow-based -unequal- budding. +7  
paperbackwriter  ^ I would disagree a little bit. "Broad based" and "narrow based" refer to how smushed the circles are. So narrow based is when the membrane bit they're sharing is small, and broad based is when they share a lot of membrane. So if just pinching off --> crypto, if they look stuck/have a flat membrane between them --> blasto +3  
jbrito718  I was also struck by the similar presentation to Blasto even though mucicarmine points straight to Cryptococcus. regardless, both are primary in lungs so I was safe picking that answer +