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A patient in California was diagnosed with malaria acquired through a blood transfusion. A discussion of this case by physicians included the following statements. Which statement is correct?
    A. The infected blood contained sporozoites.

    B. The patient should be treated with chloroquine and primaquine.

    C. The patient should be treated to eradicate the stages responsible for symptoms.

    D. The blood donor had chloroquine-resistant malaria.

    E. The patient would not be infective to mosquitoes.


And a bonus one nod

A 28-year-old man presents to the office for evaluation of a rash on his chest. He started with one oval shaped purplish area that he thought was a bruise but has subsequently developed multiple new lesions. The growths don�t hurt, itch, or bleed, but he continues to get new ones, and the existing ones are getting larger. He has never had anything like this before, has no history of allergies and denies exposure to any new medications, foods, lotions, or soaps. His past medical and family histories are unremarkable. His review of systems is significant for a 15-lb weight loss in the past 2 months, approximately 6 weeks of diarrhea, and a 3-week history of a sore throat. On examination, he is a thin but generally well appearing male. His vital signs are normal. Examination of his pharynx shows thick white plaques on the posterior pharynx and soft palate. On the skin of his chest are multiple oval shaped purple or brown macules. They are firm on palpation and vary in size from 0.5 to 4 cm in length. Several of them appear to be growing together into larger, confluent plaques.

Which of the following could be the pathogen responsible for blindness in this man?
    A. Cytomegalovirus
    B. Epstein-Barr virus
    C. Fungus
    D. Toxoplasma


I go for D,
& bonus Q- AIDS pt. with CMV retinitis..AAA..!!


CMV retinitis perfect nod ..... what`s the skin lesion ??? I know u know that smiling face

... give the first one another try smiling face


the first one I think is E. I remember reading something about being infected with one type of malarial organism confers resistance from being infected by another. But I could be just stuck on the idea and not thinking open minded.

Is the skin lesion in the second one bacillary angiomatosis , thats what I would think.

You never corrected me on the HBV questions on the reason for the Reverse transcriptase, I dont want to search through a billion things but if I was wrong the only other thing I can think of it uses its rna as a templante to create DNA and then assembles it in the nucleus

Edited by Ancylostoma on Jan 26, 2007 - 10:10 AM


Kaposi sarc is the skin lesion...I guess !!1st think sporozoites wud survive the cold storage of blood & reinfect....AA?!?!Btw: When's Ur exam Clozapine? Still in Feb smiling face

Edited by drplacebo on Jan 26, 2007 - 10:20 AM


OMG u still donno the answer shocked ... wink kidding .... I told u to double check b/c it`s a lil complicated ...

anyways I remember it is that HBV DNA is incomplete, it`s partially double stranded with one complete strand.

So, after entering the cell, the virion polymerase first complete the missing portion and make a closed circular DNA, then mRNA`s are synthesized from the DNA by host cell RNA polymerase,

then from these individual mRNA`s a full length RNA template is made which serves as the template for the viral DNA .... and virion rna dependent DNA polymerase uses that template and form the progeny DNA ... does that make any sense?

there`s also another twist about the positive and negative strand b/c i guess the poor virus get too confused to detect which one is the positive and which one is the negative strand sticking out tongue ...( since, the normal mechanism is the -ve strand is ignored and the +ve strand is used as a template for mRNA synthesis in DNA viruses but HBV is now left with its own 2 strands of DNA and a new one !!!)

so,precisely, an intermediate RNA template is used in HBV to make DNA; thats why it`s called RNA dependent DNA polymerase .... note the difference from reverse transcriptase ... in retrovirus, the viral genomic RNA is complete and reverse transcriptase just make a DNA to use it as a template for mRNA but it`s not the genome .... whereas in HBV, the product of RNA dependent DNA polymerase is "the Genome" .... I donno what I`m saying shaking head .... let me know if it`s not clear ....

and for the q`s above smiling face try harder !!!


yup .... right placebo smiling face ... `tis kaposi sarcoma nod .... still in feb dear sad .... can`t even postpone it to 28th sad .... `ve got other stuff to do disapproval .... 26th may be sticking out tongue if I need another week ...


Thanx...Whats the Answer for 1st Q?
Mine is on the last day...28 Feb.raised eyebrow

Me too a precarious situation with lots to do...confused
Gud Luck 2 U.


well I think the answer is C then. I wanted to go with this answer and then convinced myself that it was a trick question. the wording on E was a little fishy anyway. Erythrocytic shizonts when they rupture are resposible for the paroxyms of fever .

Sometimes I trick myself

the hbv explanation made was fine, thanks.

Edited by Ancylostoma on Jan 26, 2007 - 11:40 AM


I'm taking it on the 28th too, we can all fail together!!!


The answer for the 1st Q is C.

The primary goal should be to treat the patient to eliminate the erythrocytic cycle that is the cause of symptoms. This would constitute a radical cure because the liver phase only occurs if infection is initiated by sporozoites. Thus, treating with primaquine (B) is not necessary because the patient will not harbor hypnozoites. Likewise, (A) is not correct because sporozoites are only acquired from mosquitoes. Transfusion malaria is caused by schizonts and merozoites present in the transferred blood. There is no way to know that the malaria is chloroquine resistant until after treatment with chloroquine (D) and the patient, although not likely to occur, could transmit the infection to mosquitoes (E) because gametocytes would be present in the blood.

Good luck to you too placebo !! I`m sure you`ll do fine, both of u. ( only one I`m not sure about is me sad )


Whoa.!! not just the exam date, seems like we r similar with our S K E P T I C I S M
........Gr8 !!! Today's my lucky day....that too ended as per my time. Otherwise U shud have seen my imbecility regarding even Basic Q's....raised eyebrowsticking out tongue
Sure Ancylostoma !! Lets invade Prometric & show them our 'mettle'
Lets shock those ECFMG ppl. to death......nodgrin

May their soles rest in peas.

Edited by drplacebo on Jan 26, 2007 - 11:02 PM


Agreed, Its time to really put down the studying and ace it !!


Green peas !!

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