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NBME 24 Answers

nbme24/Block 3/Question#22 (22.0 difficulty score)
A 32-year-old woman recently diagnosed with ...
Epstein-Barr virus-induced brain lymphoma🔍
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 +5  upvote downvote
submitted by lsmarshall(345),
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I utothhg shti aws a kctri uoqinste necis nsik cearsnc era hte msot noocmm type of naecrcs llroeav. utB layuaclt gamon HVI apt,tiesn lr-eVIatedH acrcnse era uhmc omre nmcoom hant HeIro-latVdenn- rnscace vne(e nski n.srcac)e decuinEdVB- imryarp SCN hlypomma is hte nyol itpono ttha is sngDn-edAIfii a/icecse.nlnrsl

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... +11  
trichotillomaniac  Why you gotta do me dirty like this NBME +2  
sars  My thought process, usually wrong all the time, was that HBV (IVDU) can occur to anyone. Acute hepatitis to Chronic occurs when HBV incorporates its DNA into host and releases mutagenic proteins. This is regardless of immunosuppresion. Primary CNS Lymphoma reappears primarily when you are immunosuppressed (organ transplant, immunodeficiency, HIV/AIDS). +  



 +1  upvote downvote
submitted by krewfoo99(76),

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.