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NBME 24 Answers

nbme24/Block 4/Question#9 (51.1 difficulty score)
A 10-year-old boy who was adopted from the ...
Black flyπŸ”

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submitted by brethren_md(88),
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oeOcnahcrc usVoullv iav femlea ckbllfa.y kcBal i,sfle aklcb sink osnde,lu acl"kb g"shit aak( s.idnsleBn) Qtisoneu etsm eehr iecsersbd het kbcla olsdnue seen ni ehrcO.aconc

linwanrun1357  There is no black in the stem~~!! +4  
misterdoctor69  nodules can be hypo or hyperpigmented supposedly! +1  

submitted by madojo(163),
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submitted by syoung07(21),

There were 3 key things you needed to spot to lead you to Onchocerca. 1) little dude is from Congo 2) He's asymptomatic except for the skin nodules 3) the biggest key here was the presence of the microfilariae from the skin nodule

submitted by waterloo(71),

Reading microfilariae reminds me of three things. all from sketchy.

  1. Loa Loa --> Deer flies --> subcutaneous nodules and larva crossing eye.
  2. Onchocerca volvulus --> black fly --> deposits larva in skin which mature into adults producing microfilariae causing scattered puritiic papules and potentially eye blindness.
  3. W. Bancrofti: this is due to mosquitos and causes elephantiasis. Also has microfiliariae.

Honestly, I was looking for deer fly. But culex mosquito is west nile, reduviid is chagas. I think everyone knows ixodes and body louse is not this.

submitted by drmomo(18),
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why anc't it be celux omos?tuqi ambey creauhiewr fbaitcorn rifalssii?a

sunshinesweetheart  diff presentation - that's elephentiasis +3  
sunshinesweetheart  plus filariasis isn't the same as microfilariae +  
avocadotoast  @sunshinesweetheart wucheria bancrofti shows microfilariae on blood smear. Filariasis in the name is referring to the microfilariae +1  

submitted by tyrionwill(15),

probably only 2 parasites are related to nodules: 1. trichinella spiralis: muscle mass, muscle ache, systemic symptoms 2. onchocerca volvulus: skin nodules, without significant systemic signs until blindness

tyrionwill  probably cannot find any abnormality on the skin surface or no obvious mass found along body. only biopsy from the painful muscle can detect the larve of trichinella spiralis. however, skin change due to onchocerca is popular to be easily found when doing PE +  

submitted by linwanrun1357(9),
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EO:TN :lcoMifiarrai

iiriraciasflMo an eayrl gstae ni eth elif cecly fo cnraite stcirapai stdemneoa ni the yfimal iici.Odkcncwe-r-eaho

linwanrun1357  Only the the black fly is associated with nematodes +  

submitted by famylife(87),
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