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NBME 22 Answers

nbme22/Block 2/Question#23 (31.2 difficulty score)
A 32-year-old woman comes to the physician ...
Reduviid bug🔍

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Arportdho efnistonci

.a roTsnamypa zurci = iderduvi gub

b. asnpymraoTo ercubi = steesT lfy

.c Maialra = Aeheponsl qtomoisu

.d airslivFvu ruopG e(tWs ilNe i,uVsr eDugne) = eesAd otquoims

.e icaifraoMirle = aklbc fyl

.f hmaneiLsia isinerbisazl = ndsa lyf

.g ilBaroer ;a&pm abseBia esoIxd= tkci

.h bReckiias bekciiris pam;& aaesFnrllic tslaiursen = enaemctroDr ikct

.i Rskebiai kiwroeizap = ilec

j. Loa oal Aarcnif( eye )wrom = eder fyl

.k airuehecrW bitfanorc = iomqetouss

zoek816  West Nile Virus = Culex +1  

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agCash ,dseaesi ttripytomgeaso no dbloo em;rsa pctradhiamyooy, yltoiadnnermp ofnud in touhS eaAircm

 +2  upvote downvote
submitted by asharm10(16),

Unilateral periorbital swelling acute stage of chagas disease

 +1  upvote downvote
submitted by pg32(108),

How did anyone get this as T cruzi? That was literally the first answer I ruled out. She has swelling of the eye, but that is the only sx that fits. Chagas presents 10-20 years after initial infection, not two weeks later. It also doesn't present with recurrent fever, muscle aches and joint pain. I mostly ruled it out because of the time course.

castlblack  I made the same mistake. Tsetse flies only exist in africa. African sleeping sickness is named well. Chagas is only in south america/central. Leishmaniasis is found on both continents. +  
medjay7  The clinical presentation confused as hell, but I could recognize that Trypomastigote anywhere and definitely was not African sleeping sickness. +1  
usmleboy  She has the swelling of the eye, edema, and chest pain. T cruzi causes dilated cardiomyopathy (chest pain and edema), and the eye swelling (Romana sign) is pretty buzzwordy for Chagas. Also it looks like a trypanosome. +1  

FA 2019 p156 Does anyone know how to differentiate the picture labeled Trypanosoma brucei and cruzi?

footballa  This question is likely not important for two reason: They're both Trypansomastigotes, so of course they look almost the same. You can differentiate these two species clinically as they have very little clinical similarity in patient presentation. For these reasons there's little to no reason you would be expected to differentiate these two species by histology alone +2  
snripper  Does Chagas have recurrent fever? Because that's what pointed me to African Sleeping Sickness. +  
baja_blast  The history of travel to the Amazon is what pointed me to Cruzi over Brucei but agree it's a tough distinction to make here. In the absence of that detail I would have probably picked Tsetse fly. +1  

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