NBME 21 Arthropod vector (NBME Answers)

Retired NBME 21 Answers

nbme21/Block 3/Question#50 (reveal difficulty score)
A 32-year-old woman comes to the emergency ...
Arthropod vector 🔍 / 📺 / 🌳 / 📖
tags:

+14 upvote downvote
submitted by ∗tissue creep(133)

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Arthropod for sure, but for the record I'm pretty sure this was Chikungunya Virus. Only got this from a UWorld question as I hadn't seen it until then, but apparently the arthralgia is really bad, which is what drew me to the answer.

https://www.cdc.gov/chikungunya/index.html

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meningitis More like Zika Virus (Same a. aegypti vector) since it says she has rash associated to her bone and muscle pain. I had Zika one time (i live in Puerto Rico). Remember also dengue and Zika are Flavivirus. Dengue can cause hemolysis (hemorrhagic), and Zika is associated with Guillen Barre and fetal abnormalities. +12

nala_ula I'm shocked that I found a fellow puerto rican on this site! Good luck on your test! +2

namira dont be shocked! me too! exito! +2

niboonsh Dengue is also known as "bone break fever" which makes me think its more likely to be dengue due to the "excruciating pains in joints and muscles". https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4242787/ +25

dr_jan_itor I was thinking that its Murine typhus transmitted by fleas +

monique I would say this is more likely scenario of either Dengue or Chikungunya, not Zika virus. Excruciating pain is common in those, not in Zika. Zika has milder symptoms of those three infection. +2

jakeperalta Can confirm that Chikungunya's arthralgia is pretty horrible, from personal experience. +

almondbreeze UW: co-infection with chikungunya virus with dengue virus can occure bc Aedes mosquito is a vector of both Chiungunya, dengue, and zika +

lovebug FA2019, page 167 RNA virusesy. +

lovebug Found that Chikungunya also have Rash./// An erythematous macular or maculopapular rash usually appears in the first 2–3 days of the illness and subsides within 7–10 days. It can be patchy or diffuse on the face, trunk and limbs. It is typically asymptomatic but may be pruritic (Taubitz W, Cramer JP, Kapaun A, et al. Chikungunya fever in travelers: clinical presentation and course. Clin Infect Dis. 2007; 45: e1. ) +1

beto it is chikungunya->fever, polyarthralgia, diffuse macular rash, dengue has retro-orbital pain mostly +1

+1 upvote downvote
submitted by ∗haliburton(224)

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my notes from UWORLD: andes aegypti mosquito = dengue south, southeast asia, pacific islands, carribean, americas HA, retro=orbital pain, joint pain, muscle ache. petechiae, purpura, epistaxis, melena, throbocytopenia leukpoenia, hemoconcentration

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thomasalterman Dengue is an arbovirus. The important hints are that she was traveling in endemic (tropical) and that she has **excruciating pain in the joints and muscles**. This is why dengue is aka "break-bone fever" +

sam Same vector +

macroorchidism Yeah I messed up the question too, but after digging, the exact virus isn't important (Zika, Dengue, or Chikungyuna) since they all have arthralgia AND are Arthropod borne viruses. Another interesting fact I learned from Q banks that wasn't in FA was that Chikungyuna means "stopped walk" and happens because of severe polyarthralgia and is also associated with a rash +

+1 upvote downvote
submitted by ∗astrid93(2)

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Its Dengue because:

-Dengue, Chikungunya and Zika have: fever, maculopapular rash and arthralgias and are transmitted through Aedes aegypti. -Dengue and Chikungunya: have excruciating pain in joints, but dengue has retroorbital pain too. -Zika: low grade fever (ruled out) -Chikungunya has onset of symptoms occurs within 2 weeks (ruled out) and Dengue's onset symptoms occurs 2-10 days. The question says 4 days ago the person returned from the trip.

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+0 upvote downvote
submitted by ∗thepacksurvives(21)

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My thought was that this is endemic typhus from louse [on a cruise, rash only on the trunk, arthralgia]

Thoughts?

Honestly, even if it is dengue was the same answer shrug emoji

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uslme123 I did too ... but It looks like the timing fits better for denge. +

-2 upvote downvote
submitted by ∗apurva(101)

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I wonder i chose “sexual transmission” because same background of question stem was in AMBOSS stating the acute serum sickness like presentation for Hep B.

None the way, NBME wins.

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