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nbme24/Block 4/Question#37 (33.8 difficulty score)
A male newborn is delivered in the hospital ...
Ingestion of undercooked meat🔍,📺
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 +11 
submitted by andro(212),

Congenital Toxoplasmosis : The triad of

  • diffuse intracranial calcifications
  • Chorioretinitis
  • hydrocephalus
  • ( may or may not have Blueberry muffin rash)

    Infection in mother - either from cat faeces or undercooked meat (more common)


    Congenital CMV :

  • sensorineural hearing loss
  • chorioretinitis
  • blueberry muffin rash
  • periventricular calcifications
  • -Infection in mother will present with nonspecific symptoms of lymphadenopathy , malaise e.t.c


    Congenital Rubella : The triad of ( Gregs Triad )

  • sensorineural deafness
  • cataracts
  • cardiac defects
  • - - blueberry muffin rash

    -Infection in mother - air droplets ( Sx of polyarthritis)

    ih8payingfordis  Toxoplasma gondii FA 2019 pg 156 +  
    jbrito718  Its so fascinating how similarly congenital toxo vs CMV present +  



     +4 
    submitted by lsmarshall(426),
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    Air" tdeslpr"o onssud kiel saityerrpro alai(vs ro )wraet srdeot.pl ainalohtnI of asoapomtxl scstyoo ni tac secfe stin' ueiqt teh ms;ea ont ot ays I onwk ylatecx atwh hte oystosc ear dlhniae sa ust(j rocpiciosmc yrd atc oopp ?e.lptri)cas oItsennig fo kedcrouedon mate ot get hte sstcy is inetrclya a ORT rfo oa.tlomspax

    aposlxTmoa sa RTCHO ash aidtr of cpeayrhslu,doh cleerrab nlifccoiiatcas aenraeribtr)c,l( and .iirtioheonsritc neiitrshoritcio nca eb ni einatlgonc MCV or tslsp.moxiosoa lirivceruPteanr tcifiaslanocic ear in CV.M nolCgtaine CMV lyulaus sah giarhne os,sl zese,rsui ateelchpi rsha, reublye“rb n”fmfui ahsr, nitcii,ehirorots nad rapcriliveentur iflas.oiccactin

    usmile1  also note that toxoplasma can cause the "blueberry muffin" rash (also rubella can as well) +  
    raddad  So looking at the CDC website, it looks like "accidental ingestion of oocysts after touching cat feces" is the route you were talking about in the first paragraph, so inhalation of air droplets is wrong inherently. +2  
    zevvyt  is his small head common is Toxoplasma? +  



     +3 
    submitted by majic(9),
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    THE OMTS OMCNMO uetro fo oxoT mnstsaiirnso in aldtus in eth SUA si tegsinnio of euckoednrod pkro. vEen fi cta rliett is na opino,t ddecnkeooru orkp is tlils oerm mcm.oon

    yotsubato  Also another fun fact. Most people in France are infected by Toxo (like 80%) because of how they eat meat. (Very rare) +2  
    madojo  To add on might be TMI but most people have Toxo but are asymptomatic because its in its latent form as a pseudocyst and its not untill you are immunocompromised that it strikes +  
    suckitnbme  This patient also probably got toxo in Brazil +  
    luciana  JFYI people in Brazil love to eat rare meat at barbecues +  



     +3 
    submitted by azibird(198),

    Can anyone address the 3rd percentile head circumference? Does that qualify as microcephaly? Microcephaly plus Brazil had me sold on Zika, so I convinced myself that kissing could transmit it because I know it can transmit sexually.

    I probably should have rethought it after not finding mosquito as a choice, and the classic Toxoplasmosis triad is there, but what's with the microcephaly?

    UW ID: 15034 for those curious about Zika Classic findings are microcephaly, arthrogryposis (contractures), seizures, hypertonia, ocular abnormalities, cortical thinning, ventriculomegaly, and subcortical calcifications.

    mamabara  No answers as to why, but I also had the same line of thinking thanks to the Uworld question too... my best guess is that Toxo is the better answer based on the choices given? Even though the presentation (especially immigrating from Brazil) really made me think Zika +  
    larryd  I thought this was Zika too and put kissing. According to the CDC website, congenital Zika is more likely to present with focal pigmentary mottling and chorioretinal atrophy (vs the chorioretinits seen in the newborn in the question).https://www.cdc.gov/pregnancy/zika/testing-follow-up/zika-syndrome-birth-defects.html +