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NBME 24 Answers

nbme24/Block 4/Question#5 (62.4 difficulty score)
A 45-year-old man comes to the physician ...
Muscle biopsyπŸ”,πŸ“Ί

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submitted by sattanki(71),
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sulcMe aipn + taiorpblire mdeae si a ailsscc tpaenirnstoe rof tacoheilrln Bste assginido orf hits is a leuscm obi,ysp as hte oyrwm sklie ot otgnhua inhwti hte esmlscu.

sympathetikey  That's what you get for killing polar bears. +86  
dr.xx  That's what you get for not cooking them well. +4  
charcot_bouchard  Theres nothing called "well cooked polar bear meat" +2  

submitted by neonem(572),
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pneAyprlat alitclirenh ilse rnudoa in eumslc fo lal of the modarn tecxio masnali thta tmos oleepp 'tulwond lrlomnya hintsg leki ,arbe ldiw kbsrpar/oo eilk( ni Scetykh c)r,oMi ibg tac,s sxef,o so,dg rhos,es lea,ss uaeslrw.s In aesc uoy eneedd traheno roeans to ont thnu and nmuesoc ethes sanliam?

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

+4/- sunshinesweetheart(82),

submitted by jucapami(11),
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odlstlasigomstrlb:epwp.c/i/tho.achnh/tyswisiwle/ro./tvgich wrot atgnik a o.kol

submitted by hungrybox(1051),

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(178),
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TCEKYHS ancrhitlle iisralsp pgi a(cn be aprlo ebar o*)to nurod lagssse -&t;g- roipe bairtol tewsgaemie nda nda green udoivormtn ngstih no wlsla =;&t=g mfsro ycsts in teasdtir uslcem o(s fro hits osneutqi kames seesn taht ouy do semclu bsoyp)i e rif -tg-&; nafiialntmom of oishspolunilee cm unalgsre -&;-gt non cfceipis sa you acn ese sit lla vroe ihst eigma os its rfo mnya eedftifrn ypste fo denteoasm

submitted by bharatpillai(23),

Just adding on- Xray of large muscle groups would help in diagnosis of cysticercosis since cysts are calcified, in trichinella they are not. I think i'm the only one who got this wrong :/

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(19),

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

misterdoctor69  Sketchy micro! +