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NBME 24 Answers

nbme24/Block 3/Question#22

A 32-year-old woman recently diagnosed with AIDS is ...

Epstein-Barr virus-induced brain lymphoma

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submitted by lsmarshall(201),

I thought this was a trick question since skin cancers are the most common type of cancers overall. But actually among HIV patients, HIV-related cancers are much more common than non-HIV-related cancers (even skin cancers). EBV-induced primary CNS lymphoma is the only option that is AIDs-defining illness/cancer.

medskool123  why not hep B? i guess another whats the better answer ones... Just rem reading that it was more common with aids pts.. anyone have an idea about this? +1  
haliburton  Yes, I think CNS lymphoma as an AIDS defining illness wins the day. My thought was since SHE has AIDS it is most likely from IVDA, which has a high risk of HBV that could go undiagnosed for a long time. at 32, that might not be long enough to have HBV and get HCC (but with no immune system...?) +1  
yotsubato  God damn this is such BULLSHIT... +6  
trichotillomaniac  Why you gotta do me dirty like this NBME +  

EBV virus infections B cells. As a response there is reactive lymphocytosis (proliferation of CD8+ cytotoxic T Lymphocytes). In HIV, you will have a decrease in TH cells leading to decrease in CD8 T cells. Thus EBV will proliferate more freely as the immune response towards it (CD8 cells) are blunted. This is how i got to the answer.