TOMMYK POSTS (201-231)

[mommd]

TOMMYK POSTS (201-231)

Q. SUPER HYers that have been rounded up in the Wild West of Usual Suspects in IMMUNO Questions in the MIND OF THE MATRIX NBME!

1) A pt comes in and you see anti-centromere antibodies? Dx?

A. CREST syndrome

Q. most know Anti ds DNA and anti ANA is Systemic LUPUS, but give me the one if Drugs induce lupus?
A. anti-histone!!

Think HIS-STONE of COCAINE (drug), so assoc. histone with drugs

Q. Pt comes in and has skin lesions that are peeling off, ouch!...pathology lab reports which autoantibody

A. likely pemphigus and anti-epithelial antibody


Q. As I am doing, there are a WHOLE SLEW of autoantibodies that you must know that I cannot cover all, know them cold because they are easy points if they are highly specific.

Quickie, can you reverse chronic kidney rejection with cyclosporin A?

A. NOOOOOOO,

but you can suppress ACUTE REJECTION!


Q. BIGGIE JUICE?

A transplant patient comes to you and cries because after a year her kidney transplant makes her eyes yellow and her tummy is FAT (hepatosplenomegaly). What is the MOA? Think.


A. This one was a little tricky,

NOT so much chronic rejection symptoms, but think

Graft vs. host disease!! All the organs are systemically knocked out!


Q. You see a slide with large cells and hyaline bodies in the last female kidney transplant patient. What is the virus (HINT) and the Dx?

A. This is good HYer. She is immunocompromised from cyclosporine, so she is at risk for CMV, which you see. Give gangclovir (Not acyclovir), if she is resistant still, give foscarnet.


Q. This connects with my previous concept:

KEY!

Why did you give her Ganciclovir and not Acyclovir? And if she was resistant, why did Foscarnet work????
A. ganciclovir IS phosphorlyated like acyclovir, but it LOVES CMV DNA polymerase (MOA). Foscarnet worked because it did not need viral kinase activation!!!!! (resistence issue)

WOW!


Q. WE JUST TALKED ABOUT acyclovir, gancyclovi, foscarnet.

Which body organ is at risk of toxicity?
A. all are nephrotoxic and ganciclovir can cause pancytopenia!


Q
We just mentioned CMV right?

Your door opens. The patient reports decreased visual acuity, floaters, and loss of visual fields on one side. Ophthalmologic examination shows yellow-white areas with perivascular exudates. Hemorrhage is present and is often referred to as having a “cottage cheese and ketchup” appearance. Lesions may appear at the periphery of the fundus, but they progress centrally.

OKOKOK, this is CMV, I need you to know CMV retinitis is common in HIV, but tell me:

The VIRAL FAMILY, and DNA Structure/Envelope


A. CMV is very tested. (As an aside, it is horribly affecting to unborn babies), IT along with VAV and EBV and HHV are all HERPES viruses with DS (Double strand), linear envelope

valuemd.com

Q. But wait there is MORE,

our poor CMV patient has HIV, right? Concept is what is the structure of HIV?????????? be specific.

A. This RNA virus has an envelope, SS+, square, and is one of the only two RNA viruses to replicate in the NUCLEUS!


Q. A child comes in with pink eye and half his kindergarten has symptoms of this common virus? Give me structure?
A . Adenovirus is DS linear wihout an envelope! You have to know the details because one of the answer choices will have DS linear with envelope. Everyone limits to two choices. Don't be trapped!

Q. NOW, you see a mom with a child coming in with a rash on his cheeks and is tired a lot. What virus is this for his classic combo? And give structure!!!!!!!!!
A. Parvovirus B19, 5th disease, shown a picture, no envelope, SS linear

(This is the only DNA virus that is SS, YOU HAVE TO START LUMPING IN EVERY WAY YOU CAN UNLESS YOU ARE GOD, AND ONLY GOD DOES NOT HAVE TO LUMP)

Another LUMP,

Hi (Hepatitis/Herpes) Poxy (Poxvirus) Lady, holding an ENVELOPE with a Valentine's Day card!

MNEMONIC for the 3 DNA viruses with an envelope, the others DON'T have an envelope.

OH! INCIDENTALLY, TODAY IS VALENTINE'S DAY. SO HAPPY VALENTINE'S DAY!
Q. Whew, I am getting tired, but>>>

A child comes in with his face looking like chickenpox but serology tells you it is Measles. Also his physical reports a grayish spot on the inside of his mouth before the measles started (Koplick spots). Give me the structure?
A. This is a NEGATIVE sense, SS, linear, NONSEGMENTED.

UGLY, UGLY. This structure stuff IS ALL OVER THE NBME's MIND, but it is so hard to master. Click on my posts over and over while covering the bottom part with the answer until you make NO mistakes...

I am devoting a lot of effort, so DON'T LET ME DOWN, LET'S WIN!

Q. THEY may give an EM with the previously mentioned MEASLES VIRUS, what does the capsid look like and what are the 3 other viruses in this family?

A. The capsule is a HELIX, and RSV, Croup virus, and Mumps are all part of this Paramyxovirus family.

MAN, this is a PAIN! Right?

Q. HERE IS A CLASSIC, LIKE HAPPY DAYS AND THE FONZ! OR Laverne and Shirley...

You see a female young sexually active patient with genital warts you biopsy to be HPV. (SO MANY SECONARIES, like cervical cancer/cone biopsy needed/CIN grading/colposcopy) EVERYTHING IS CONCEPTS!

Sorry but to the case...the HPV is what structure and family?
A.
This is a Papovavirus, with NO envelope, DS and circle shaped! Another secondary is back to your HIV patient, he can get another virus from his HIV that slams his brain: JC virus...just mentioning...

Are you guys getting these? These are so boring and rote memory....

Q.
Oh dear, you will see a million of these:

A kid comes in with the common cold and serology says it is not adenovirus. What is the structure?

Q. OH BOY,

This ain't OLD YELLER, but a raccoon that bit one of your peds kids and his serology is Rabies!! Quickly, structure! But first you gotta be quick and give the kid Imogam/Human Rabies Immunoglobulin.
A. this neg stranded virus is SS and HELICAL


Q. Emergency!
Another peds patients came from Africa with serology of EBOLA! Structure! Please

A. Ebola is neg. sense, enveloped, linear, helical (JUST LIKE RABIES)! Your poor patient must be isolated because this virus cause vascular hemorrhages!!!!! And NO DRUG (proven) at least is avaliable! AHHH!

Q.
BIG ONE!

A case of a peds kid comes with a 4 day rash over his trunk (you need serology so I tell you it is Rubella). What is this Togavirus's structure?
A. Here is a positive sense, SS, linear, square virus, with an envelope. You will get a couple of exactly these concept questions which will make you have diarrhea because it is so hard. Think of mnemonics....

Q. YOU HAVE TO KNOW THIS ONE, because it is EVERYWHERE!

Case: You have a peds kid with serious diarrhea from a virus. What is this everywhere virus and the structure???????
A. THIS IS ROTAVIRUS, a mainstay in peds offices.

IT IS THE ONLY RNA VIRUS THAT IS DOUBLE STRANDED!

And it is linear, square, with an envelope.

THIS STUFF IS REALLY HARD, I THINK I AM GETTING DIARRHEA MYSELF!!!!!! KEEP CLICKING MY POSTS TO QUIZ YOURSELF, this part I think is the hardest because the answer choices will be so hairline similar.

Q. CLASSIC GRANDDADDY QUESTION !

Case: A couple of your newlywed patients go on a cruise ship. Instead of a good time, they come back to your clinic with the worst honeymoon ever!! All everyone on the ship did was diarrhea!!!!!!!!!! (You are walking up a ladder and you are hearing something spatter..diarrhea..uh..uh...you are walking down the hall and you are hearing something fall diarrhea...)

What is this classic bug and the structure?
A. This is the FAMOUS NORWALK Virus. IT is SS positive sense linear and square with NO envelope.

I am hoping that for these last series of posts about viral structure I see that there are thousands of views becuase that is what it WILL take to master them and pass them.

IT IS SO BORING RIGHT? AND SO HARD. I mean, gosh!

Oh, a quick personal mnemonic... PCR we know stands for that DNA amp test. And so remember PCR stands for PICORNA, Calci, Reo viruses. If you recall the families, then PCR RNA viruses are the only ones without an envelope.

YOU HAVE TO REPEAT THESE A THOUSAND TIMES, there is no other way. All the people I spoke to said this was the hardest thing on their USMLE because they could get the bug right, but they were like pos or neg sense, whatever?

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Q. HERE IS A MEGA HY and a lumper:

Two patients of yours walk in with antibody specific for Hepatitis A and E

Another comes in with a tattoo and she has Hep C

A third jumps in your office crying bc she has Hep B

Give me the structures (NBME WILL ASK YOU THIS)


A. Good, we can LUMP Hepatitis A and E wtih SS pos. sense, linear, square and no envelope. RNA

However, Hep C is also SS pos. sense, linear, square, but ENVELOPED!RNA

NOW Hep B is a DNA virus curved on EM WITH an ENVELOPE!


You feel you want to avoid this, but the secondaries will address these..

valuemd.com

Q.
Case: A rocker teen comes in with serology positive for COXSACKIE B, AN NBME FAVORITE.

Two questions:

What disease and sorry sorry to ask, but give me structure!!!
A. This bug is part of Picronaviruses and is like Hep A and E in that it is

!) positive sense, RNA, SS, and square.

2) The disease is MYOCARDITIS



I think this is all so hard you need a mnemonic so let me give you all one and you make one up yourself or you are dead b/c it is so much mumbo jumbo: RNA viruses first:

For the POS. SENSE, I think of the viruses that are not SO BAD because they are:
Rhinovirus, Coxackie, Hepatitis A, E, C, Rubella (non-congenital one), Coronavirus (common cold), and HIV....(HIV I think is now not SO BAD because of the new drugs)

(The NEG SENSE are all the other RNA viruses)...(for example Rabies and Ebola are neg. sense because it is so negative/bad to get them)



For getting straight the strands, know ALL OF THE RNA viruses are SS except for Reo/Rotavirus which are DS.


For the Capsule, aside from Corona (common cold) which is not THAT DEADLY, THE DEADLY VIRUSES ARE HELIX shaped (e.g. INfluenza on an older man, untreated mumps, rabies, ebola, LCV, Hantavirus (hemorrhagic fever) The others are all square...


NOW, the DNA viruses you identify because they are HAPPY!

(H) Hepatitis B
(A) Adenovirus
(P) Poxvirus
(P) Papovavirus
(P) Parvovirus B19
Y

All the DNA viruses are DS except Parvo
You send an ENVELOPE with an p OX to HP (Hewlet Packard Co) [The p OX stands for poxvirus and the HP stands for Hepatitis B and Herpes]


These mnemonics work for me, but you NEED some otherwise it is hopeless.... Try to be creative!

I think this is all so hard you need a mnemonic so let me give you all one and you make one up yourself or you are dead b/c it is so much mumbo jumbo: RNA viruses first:

For the POS. SENSE, I think of the viruses that are not SO BAD because they are:
Rhinovirus, Coxackie, Hepatitis A, E, C, Rubella (non-congenital one), Coronavirus (common cold), and HIV....(HIV I think is now not SO BAD because of the new drugs)

(The NEG SENSE are all the other RNA viruses)...(for example Rabies and Ebola are neg. sense because it is so negative/bad to get them)



For getting straight the strands, know ALL OF THE RNA viruses are SS except for Reo/Rotavirus which are DS.


For the Capsule, aside from Corona (common cold) which is not THAT DEADLY, THE DEADLY VIRUSES ARE HELIX shaped (e.g. INfluenza on an older man, untreated mumps, rabies, ebola, LCV, Hantavirus (hemorrhagic fever) The others are all square...


NOW, the DNA viruses you identify because they are HAPPY!

(H) Hepatitis B
(A) Adenovirus
(P) Poxvirus
(P) Papovavirus
(P) Parvovirus B19
Y

All the DNA viruses are DS except Parvo
You send an ENVELOPE with an p OX to HP (Hewlet Packard Co) [The p OX stands for poxvirus and the HP stands for Hepatitis B and Herpes]


These mnemonics work for me, but you NEED some otherwise it is hopeless.... Try to be creative!


Q. THE WAY NBME'S VERSIONS OF THE TEST ARE THAT SOMEONE IN CHINA WILL BE ASK TOXOPLASMA, SOMEONE IN USA WILL BE ASKED TRICHOMONAS, SOMEONE IN INDIA WILL BE ASKED PLASMODIUM, ETC. SO THE CONCEPT IS THAT TO ANSWER CONCEPT #47 (E.G.), YOU HAVE TO MASTER SAY 50 FACTS TO GET THAT ONE QUESTION RIGHT BECAUSE YOU DON'T KNOW WHICH VERSION YOU WILL GET... SO BACK TO THE CONCEPTS:

You KNOW Trichomonas is SO COMMON in clinics and you know the drug?

A. metronidazole

Q. You have a patient with a history of travel to Mexico. Did I ask this? I dunno..

He has bloody diarrhea, that should be enough you know the bug to treat him with what drug? AND, the next day he comes back after a cocktail party and said he threw up and had a red rash on his face? What happened? VERY VERY TESTED AND KEY POINT THAT I THINK IT IS GOOD THAT THE NBME TESTS THIS.
A. This is classic dysentery from Entamoeba histolytica/amebiasis. He may present with abd pain like pancreatitis.

The IMPORTANT drug reaction with METRONIDAZOLE (which is trade name Flagyl) is a Disulfiram like reaction with alcohol!!!!!!!!


Q. This WILL BE ON YOUR TEST (well if not YOU then the GUY NEXT TO YOU):

A patient with travel to India (a great country with an exploding GDP), comes back with anemia and he tells you he was bitten by a mosquito. What bug and drug? Be specific!!!!!
A.
Plasmodium malariae, give him Chloroquine and or Quinine.

KNOW a side effect of Chloroquine is visual changes and tell him not to take with Mg antacids because it delays aborption and people with Plasmodium may take an antacid due to tummy ache

Q. NOW, another traveler, this time from Africa, comes with bitten by a mosquito and you see the typical malarial signs:

FEVER, VOMITING, MILD SEIZURES, ANEMIA, ENLARGED SPLEEN/LIVER

Which Palsmodium does he have most likely?

A. NBME wants you to know that Plasmodium falciparum is more common in Africa while in the previous case Plasmodium Malariae is more common in India. There is a prodrome and time lag since:

The bite of an infected mosquito introduces asexual forms of the parasite, called sporozoites, into the bloodstream. Sporozoites enter the hepatocytes and form schizonts, which are also asexual forms. Schizonts undergo a process of maturation and multiplication known as preerythrocytic or hepatic schizogony. In Plasmodium vivax and Plasmodium ovale infection, some sporozoites convert to dormant forms called hypnozoites, which can cause disease after months or years. Very important to know the above mouthful of words I wrote!

OH, you treat Falciparum and Malariae the same way, Chloroquine


Q. We MUST COMPARE AND CONTRAST FOR THE INFO TO STICK...so

You get a traveler from India with that mosquito bite and the aforementioned MALARIAL symptoms, the travel and symptoms will NAIL the diagnosis for you. But this time she complains the malarial symptoms recur and relapse over the past two years. What two bugs do this and what drug must you add to the regimen and WHY?
A. The forms Plasmodium Vivax and Ovale are cyclical and have dormant stages called hypnozoites in the liver. So, you must ADD

PRIMAQUINE to the regimen.

KNOW THE MOSQUITO'S NAME is Anopheles. Even mosquitos like the sound of their own NAME!

Q. You are shown a sllide of the horrible Pneumocystis carinii in an HIV patient.

1) What is the lung X-ray classic finding?
2) Method of infection
3) Drug of choice?
4) When should prophylaxis have BEEN STARTED? KEY POINT, give T-cell count (hint )
A. 1) Perihilar interstitial infiltrates

2) Inhalation of cysts

3) Trimethoprim-sulfamethoxazole (Bactrim, Septra, Co-trimoxazole)

4) Probably CD4 count less than 200 and not on PCP prophylaxis.

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