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NBME 21 Answers

nbme21/Block 3/Question#50 (60.0 difficulty score)
A 32-year-old woman comes to the emergency ...
Arthropod vector🔍
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 +12 
submitted by tissue creep(112),
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tdrporAho rof sru,e utb orf eth rrdoce Im' rytpet rsue ihts swa gahuyuCiknn Vis.ur ynlO got hits frmo a rUloWd seoitqun sa I 'hdant enes it tuinl he,nt ubt aatplnyerp eht aritgalahr is aerlly ba,d wihch is hatw rdwe em ot het wensa.r

d.wnxukhwsv.ttmpa:/nc/huclwh/.ggnditeyoi/c

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/ +21  
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  



 +0 
submitted by haliburton(213),
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ym ontse romf WUOL:RD edans tigpyea ouoimsqt = denu ge os,thu utestahso ,saia facicip s,nlisad aebrncra,i e asciarm ,AH rlbir=toatreo pa,in ojint n,pai elsucm eca.h teaceiehp, rpa,puur ,aitepssix em,nlae haircoo obteynpt i,lkpauoeen ecornheotomctnnia

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 +  
sam  Same vector +  



 +0 
submitted by thepacksurvives(14),
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yM ottuhhg asw taht siht si mceedin thpsyu romf ousle o[n a uri,ecs ashr olny on het tnruk, i]hraraaglt

sghTthuo?

,yeltonHs nvee if ti is eengud wsa eht emas rsnewa grshu ieojm

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



 -1 
submitted by apurva(73),

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.