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USMLE® Step 1 questions

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USMLE® Step 1 style questions USMLE

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A 35-year-old woman comes to an outpatient clinic to evaluate substernal chest pain and pain with swallowing. She immigrated from India six months ago, and this is her first time visiting a physician in the United States. She is sexually active with male and female partners, and she uses condoms inconsistently.Vaccinations are up to date. Temperature is 38.11°C (100.6°F), pulse is 99/min, respirations are 20/min, and blood pressure is 120/75 mmHg. Physical examination reveals a frail and cachectic woman. Oral examination reveals white plaques on the buccal mucosa that can easily be scraped away, revealing erythematous mucosa. Microscopic examination of the oral lesions is shown below. Which of the following laboratory findings is most suggestive of this patient's underlying disease process?
CDC Public Health Library 

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Candida spp.

amphotericin B p. 196

azoles p. 196

catalase-positive organism p. 125

echinocandins p. 197

immunodeficiency infections p. 116

osteomyelitis p. 177

tricuspid valve endocarditis and p. 321

vulvovaginitis p. 179

Candida albicans p. , 150

HIV-positive adults p. 174

T cell dysfunction p. 114

treatment p. 723

Diaper rash

Candida albicans p. , 150

AIDS (acquired immunodeficiency syndrome)

Candida albicans p. , 150


Candida albicans and p. 150


Candida albicans p. , 150


Candida albicans p. , 150, 723

Amphotericin B p. 195

Candida albicans p. , 150, 723


Candida albicans p. , 150


Candida albicans p. , 723

Immunocompromised patients

Candida albicans in p. 150


Candida albicans in p. 150

Nystatin p. 196

Candida albicans p. , 150, 723

Substance abuse

Candida albicans p. , 150


Candida albicans p. , 150

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Candida is a yeast, not the maple syrup-loving country in North America - although Candida can be found in Canada as well!

Candida sometimes causes a mild yeast infection, but in some situations, can get into the bloodstream and cause severe illness.

Now, there are various types of Candida species, and over twenty of them cause disease in humans - C. albicans, C. parapsilosis, C. tropicalis, C. glabrata, C. krusei, C. auris, the list goes on.

Of these, the most common one is C. albicans. Candida is found throughout the body; it likes warm, moist environments like the mouth, the diaper region of babies, and in women it can be found in the vagina.

Now, it’s normal for microbes - bacteria, fungi, and viruses - to live all over the body, but each microbe is slightly different in terms of whether it’s colonizing the body - in other words just living and not causing any problems, or whether it’s infecting the body, causing some degree of tissue damage or destruction.

An important factor is exactly how much of a microbe is present.

Candida is considered an opportunistic microbe.

When the amount of Candida is relatively low, it's harmless.

But if a person’s immune system is weakened or if there’s less competition for the Candida, then the amount of Candida can increase - and that’s called Candida overgrowth.

Now, Candida can exist in multiple forms - it’s a bit like a chameleon.

Sometimes the cells can appear round or oval and these are called yeast cells, other times it can appear like hyphae where it looks like long thin filaments - kind of like a segmented cactus plant.

It can also take an in-between appearance called pseudohyphae.

Each of these morphologies or “looks” reflect the same Candida cells that are expressing different protein profiles, and they give the cells different properties.

When the Candida is in “yeast mode” it’s better at moving from one part of the body to another, whereas when it’s in “filamentous mode” it’s better at invading tissues.


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