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NBME 24 Answers

nbme24/Block 4/Question#5 (66.1 difficulty score)
A 45-year-old man comes to the physician ...
Muscle biopsyπŸ”,πŸ“Ί

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submitted by sattanki(72),
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cuelsM ainp + aiireblprto meade is a scsacli snenrpetoati ofr hnoacliretl ipias.slr Best aossdiing ofr tish si a clumse pyi,sbo sa hte rywom seilk ot uthoang iwthin eht umss.lce

sympathetikey  That's what you get for killing polar bears. +90  
dr.xx  That's what you get for not cooking them well. +5  
charcot_bouchard  Theres nothing called "well cooked polar bear meat" +2  

submitted by neonem(578),
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telprypanA ralinhiclte ilse anroud in lmuecs of lla fo teh dnaorm ictxoe nslamia thta omst epoelp nulwtod' lrmaolyn nhgtis ekil ra,eb ldiw koaobrs/pr e(kil in eShytkc icrMo,) big tcas, sx,ofe dgos, oss,rhe lsa,se lr.uwasse In esac you eended taheorn oranes to nto htnu nda mseuonc htsee ?sianmal

how to rule out the others:

we would see eosinophilia, but obvi this wouldnt tell us which helminth is involved

Trichinella larvae bury themselves inside muscle tissue rather than remain in the intestine as in other roundworm infections, so stool sample tests don't often show evidence of the parasite

gram stain of stool is a pretty nonspecific test used for campylobacter enteritis; this dude doesnt have diarrhea...and lastly, xray of muscle aint gonna tell u a thang lolz

+5/- sunshinesweetheart(94),

submitted by jucapami(11),
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he/dt.trit/lvsopwbglrsspwi/aa:lwnlcoi/iegs..thcohoi/csytmh twor kaignt a ol.ok

submitted by hungrybox(1108),

vs. eggs (ova) in stool β†’ Hookworms*, Ascaris

vs. larvae in stool β†’ Strongyloides stercoralis

vs. scotch tape test β†’ E vermicularis

hookworms β†’ Necator Americanus, Ancylostoma duodenale

(source: sketchy)

submitted by madojo(181),
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HKTYSEC enrchtalil apsrsiil pig n(ac be poarl baer too*) urnod sesalsg &--t;g oerpi aioltbr etaw esagednmi nda gnere ovrd tumino tghsin on awlsl =&;=gt rfsmo stsyc in dtritaes lsmcue (os fro sthi usqoneit keams nssee htta uyo do lemcsu )pysibo e fri -&g-t; maioaftimnnl of puilihnlesmoe ocs aurslegn ;-g-t& nno ccfieisp as uoy cna see ist lal eovr ihts amige os tsi ofr amyn ferfentdi ypets fo neosdtaem

submitted by bharatpillai(33),
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uJts aiddgn n-o ayrX fo rleag eumscl ogspru doulw plhe in sidisonga of reosctsyccisi senic sycst ear dilceaci,f in tclhnarilei hyte are t n.oI nkthi i'm teh lnyo one ohw tgo stih wgrno /:

misterdoctor69  Maybe so, but I think that if we get any questions concerning cysticercosis, it would be neurocysticercosis, so you'd do brain imaging instead... Additionally, as per the CDC: muscle cysticercosis is usually nontender?: +  
brs  I think everyone who has watched House M.D. S1 E1 gets a chance to make it wrong. +  

submitted by haozhier(20),

How do you guys know about this? I chose stool O&P...and muscle biopsy is not mentioned anywhere...

misterdoctor69  Sketchy micro! +