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Retired NBME Free 120 Answers
takayasuarteritis
Why does his cell differential show no eosinophilia? Schistosoma is a worm..?
+2
takayasuarteritis
It also says in FA that SCC of bladder is associated with painless hematuria. My dude in the question stem is having "pain with urination that has increased in severity during the past month."
+5
melchior
@Takayasuarteritis, technically he does have eosinophilia. Reference range is 1 - 3%. His is 5%. Also, although SCC of bladder presents with painless hematuria, schistosomiasis itself can have hematuria, and that hematuria can be painful.
+2
bekindstep1
FA (2019 pg 160) does say it would be painless specifically which is what made me lean against schistosomiasis
+1
itsalwayslupus
I think the calcifications, immigration from Africa, eosinophilia, chronic inflammation, and granuloma formation (which can occur with a schistomiasis infection) all together (+ a very slight fever) would all lead to Schistosomiasis, and you would just have to ignore that urination is painful, because many other factors could be causing that too outside of the traditional acute schistosomiasis infection. The pain here is just not the most important factor I don't think.
+11
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submitted by โbwdc(697)
Schistosomiasis is a parasitic worm particularly endemic in Africa (Egypt, in particular, comes up the most on questions) that is most associated with chronic cystitis. Calcifications of the bladder wall are essentially pathognomonic. Chronic infection is associated with an increased risk of squamous cell carcinoma of the bladder (as opposed to the usual urothelial/transitional cell).