Check out today’s Step 1 Qmax Question Challenge.
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A 45-year-old woman with AIDS is brought to the emergency department with a temperature of 38.8°C (101.8°F), malaise, and altered mental status, but no other history is available. Lumbar puncture shows:
Opening pressure: 230 mm H2O
WBC count: 3500/mm³
Protein: 120 mg/dL
Glucose: 44 mg/dL
A bronchoalveolar lavage specimen is stained with India ink, and results are shown in the image.
Treatment with which of the following medications should be started?
A. Acyclovir
B. Ceftriaxone
C. Flucytosine
D. Nystatin
E. Ribavirin
F. Vidarabine
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C.
C
Flucytosine specific for Cryptococcus Neoformans shown here
Is Cryptococcosis an Opportunistic disease?
Well, this question is kind of “defective” for lack of a better term and here is why; the question writer is expecting you to choose Flucytosine. But in real world, you never ever use flucytosine alone but the question is suggesting that very idea. Flucytosine, when used, is always part of a multi drug therapy. For the real test, USMLE would never asses your knowledge about Flucytosine the way this question is asking you. In the context of this question, Flucytosine must be a distractor rather than a correct choice! Just my two cents’ worth on this!
C.