{"id":4238,"date":"2024-09-11T13:52:55","date_gmt":"2024-09-11T13:52:55","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=4238"},"modified":"2025-10-01T11:38:23","modified_gmt":"2025-10-01T19:38:23","slug":"usmle-step-1-question-of-the-day-pathogen-test","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-pathogen-test","title":{"rendered":"USMLE\u00ae Step 1 Question of the Day: Pathogen test"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-pathogen-test\/#The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\" >The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-pathogen-test\/#Incorrect_answer_explanations\" >Incorrect answer explanations<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-pathogen-test\/#A_Nonseptate_hyphae_branching_at_wide_angles\" >A. Nonseptate hyphae branching at wide angles<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-pathogen-test\/#C_Septate_hyphae_branching_at_acute_angles\" >C.&nbsp;Septate hyphae branching at acute angles&nbsp;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-pathogen-test\/#D_Forms_germ_tubes_at_hot_temperatures\" >D.&nbsp;Forms germ tubes at hot temperatures<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-pathogen-test\/#E_Gram-positive_lancet-shaped_diplococci\" >E.&nbsp;Gram-positive, lancet-shaped diplococci<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-pathogen-test\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-pathogen-test\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-pathogen-test\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><em><strong>Prepare for your USMLE Step 1 exam with this question focused on identifying pathogens in immunocompromised patients. Understand the presentation and diagnostic features of Cryptococcus neoformans and other pathogens in similar settings.<\/strong><\/em><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 45-year-old man is brought to the emergency department due to confusion and altered mental status. His friend, who brought him in, states the patient has been complaining of&nbsp;fevers accompanied by malaise for the past 2 weeks. The patient is currently living in a homeless shelter, but oftentimes he is seen sleeping on the streets by his friends. Medical history is unknown, but a month ago the patient was hospitalized for&nbsp;Pneumocystis jirovecii&nbsp;(formerly&nbsp;P. carinii) pneumonia. Temperature is 38.5\u00b0C (101.3\u00b0F), pulse is 80\/min, and blood pressure is 135\/85 mmHg. On physical examination, the patient is&nbsp;lethargic and mildly confused. Neck is supple, and there are no focal signs. The patient\u2019s arms show multiple needle marks. The pathogen most likely responsible for this patient\u2019s condition is most likely to show which of the following on further testing?&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A. Nonseptate hyphae branching at wide angles<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B.&nbsp;Budding, encapsulated yeast&nbsp;&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C.&nbsp;Septate hyphae branching at acute angles &nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D.&nbsp;Forms germ tubes at hot temperatures&nbsp;&nbsp;<\/strong><strong>E.&nbsp;Gram-positive, lancet-shaped diplococci<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Scroll down for the correct answer!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_USMLE%C2%AE_Step_1_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s USMLE\u00ae Step 1 Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B.\u00a0Budding, encapsulated yeast<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the Main Explanation, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_answer_explanations\"><\/span>Incorrect answer explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"A_Nonseptate_hyphae_branching_at_wide_angles\"><\/span>A. Nonseptate hyphae branching at wide angles<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>These features depict Mucor and Rhizopus spp. that can cause mucormycosis in diabetic ketoacidosis and\/or neutropenic patients (e.g. leukemia). Mucormycosis typically presents as headache, facial pain, and a black necrotic eschar on the affected area because the fungi proliferate in blood vessel walls.&nbsp;&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"C_Septate_hyphae_branching_at_acute_angles\"><\/span>C.&nbsp;Septate hyphae branching at acute angles&nbsp;<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;These features depict&nbsp;Aspergillus fumigatus, which is a type of fungus that can be found throughout the environment. Healthy individuals are usually asymptomatic, but immunocompromised patients are at risk for developing invasive disease. It classically presents with&nbsp;fever, chest pain, shortness of breath, cough, and\/or hemoptysis.&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"D_Forms_germ_tubes_at_hot_temperatures\"><\/span>D.&nbsp;Forms germ tubes at hot temperatures<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;These features depict&nbsp;Candida albicans,&nbsp;which is a dimorphic fungus that forms pseudohyphae and budding yeasts at 20\u00b0C and germ tubes at 37\u00b0C. Immunocompromised hosts are at risk for invasive disease. Invasive candidiasis can present anywhere from&nbsp;minimal fever to acute sepsis syndrome (similar to bacterial infection). However, it is not typically a cause of meningitis.&nbsp;&nbsp;<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"E_Gram-positive_lancet-shaped_diplococci\"><\/span>E.&nbsp;Gram-positive, lancet-shaped diplococci<span class=\"ez-toc-section-end\"><\/span><\/h3>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;Gram-positive, lancet-shaped diplococci describes&nbsp;Streptococcus pneumoniae, which is the most common cause of bacterial meningitis in adults of all ages. However, pneumococcal meningitis typically causes severe, life-threatening manifestations within hours to days of inoculation, not weeks as in this patient.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient is&nbsp;immunocompromised&nbsp;(recent&nbsp;Pneumocystis jirovecii&nbsp;infection, with evidence of risk factors such as needle marks and homelessness), likely due to undiagnosed HIV infection. The constellation of&nbsp;indolent course,&nbsp;headaches&nbsp;and immunosuppression, from the options above, favors the diagnosis of&nbsp;Cryptococcus neoformans&nbsp;meningitis&nbsp;(neck stiffness is absent in 2\/3 of patients). The subacute and chronic nature of this condition is caused by capsular proteins produced by&nbsp;Cryptococcus&nbsp;which obstruct cerebrospinal fluid outflow, resulting in symptoms of elevated intracranial pressure (e.g., headache, vomiting, confusion, cranial nerve VI palsy).&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Cryptococcus neoformans is a&nbsp;budding, heavily encapsulated yeast&nbsp;(not dimorphic) that can be found in soil and pigeon droppings. It is acquired through&nbsp;inhalation&nbsp;of spores with hematogenous dissemination to the brain meninges. Confirmation of diagnosis requires identification of the encapsulated yeast in cerebrospinal fluid (e.g. India ink stain) or detection of the polysaccharide antigen.&nbsp;&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" height=\"649\" width=\"1024\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/cryptococcus-neoformans-meningoencephalitis.png?w=1024\" alt=\"cryptococcus neoformans meningoencephalitis\" class=\"wp-image-4240\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/cryptococcus-neoformans-meningoencephalitis.png 1244w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/cryptococcus-neoformans-meningoencephalitis.png?resize=300,190 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/cryptococcus-neoformans-meningoencephalitis.png?resize=768,486 768w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/cryptococcus-neoformans-meningoencephalitis.png?resize=1024,649 1024w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Cryptococcus neoformans&nbsp;is a budding, heavily encapsulated yeast that can cause meningoencephalitis almost exclusively in&nbsp;immunocompromised patients. It typically presents with an indolent course with headache fever and malaise due to elevated intracranial pressure. Stiff neck and photophobia are not always present.&nbsp;&nbsp;&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Zunt JR, Baldwin KJ. Chronic and subacute meningitis. Continuum (Minneap Minn). 2012 Dec;18(6 Infectious Disease):1290-318. doi: 10.1212\/01.CON.0000423848.17276.21. PMID: 23221842.&nbsp;USMLE Step 1: 2019 a student-to-student guide. New York: McGraw-Hill Medical.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;________________________<\/em><\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><em><strong>Want more USMLE\u00ae Step 1 practice questions? Try Osmosis by Elsevier today! Access your&nbsp;<em><strong><a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a><\/strong><\/em>&nbsp;and find out why millions of current and future clinicians and caregivers love learning with us.<\/strong><\/em><\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/ultimate-guide\/usmle-step-1\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/the-ultimate-guide-usmle-step-1-banner.png?w=700\" alt=\"The Ultimate Guide to the USMLE Step 1: Everything you need to know\" class=\"wp-image-760\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/the-ultimate-guide-usmle-step-1-banner.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/the-ultimate-guide-usmle-step-1-banner.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><figcaption class=\"wp-element-caption\"><em><em><sub>The United States Medical Licensing Examination (USMLE\u00ae) is a joint program of the Federation of State Medical Boards (FSMB\u00ae) and National Board of Medical Examiners (NBME\u00ae). Osmosis is not affiliated with NBME nor FSMB.&nbsp;<\/sub><\/em><\/em><\/figcaption><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Prepare for your USMLE Step 1 exam with this question focused on identifying pathogens in immunocompromised patients. Understand the presentation and diagnostic features of Cryptococcus neoformans and other pathogens in similar settings. A 45-year-old man is brought to the emergency department due to confusion and altered mental status. His friend, who brought him in, states [&hellip;]<\/p>\n","protected":false},"author":202,"featured_media":4239,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[27,1366,1369],"tags":[],"class_list":["post-4238","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicine","category-questions","category-step-1-questions"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>USMLE\u00ae Step 1 Question of the Day: Pathogen test - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/usmle-step-1-question-of-the-day-pathogen-test\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"USMLE\u00ae Step 1 Question of the Day: Pathogen test - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Prepare for your USMLE Step 1 exam with this question focused on identifying pathogens in immunocompromised patients. Understand the presentation and diagnostic features of Cryptococcus neoformans and other pathogens in similar settings. A 45-year-old man is brought to the emergency department due to confusion and altered mental status. 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