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NBME 21 Answers

nbme21/Block 3/Question#50

A 32-year-old woman comes to the emergency ...

Arthropod vector

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 +6  upvote downvote
submitted by tissue creep(25),

Arthropod for sure, but for the record I'm pretty sure this was Chikungunya Virus. Only got this from a UWorld question as I hadn't seen it until then, but apparently the arthralgia is really bad, which is what drew me to the answer.

https://www.cdc.gov/chikungunya/index.html

meningitis  More like Zika Virus (Same a. aegypti vector) since it says she has rash associated to her bone and muscle pain. I had Zika one time (i live in Puerto Rico). Remember also dengue and Zika are Flavivirus. Dengue can cause hemolysis (hemorrhagic), and Zika is associated with Guillen Barre and fetal abnormalities. +6  
nala_ula  I'm shocked that I found a fellow puerto rican on this site! Good luck on your test! +  
namira  dont be shocked! me too! exito! +1  
niboonsh  Dengue is also known as "bone break fever" which makes me think its more likely to be dengue due to the "excruciating pains in joints and muscles". https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4242787/ +2  
dr_jan_itor  I was thinking that its Murine typhus transmitted by fleas +  




 +0  upvote downvote
submitted by haliburton(82),

my notes from UWORLD: andes aegypti mosquito = dengue south, southeast asia, pacific islands, carribean, americas HA, retro=orbital pain, joint pain, muscle ache. petechiae, purpura, epistaxis, melena, throbocytopenia leukpoenia, hemoconcentration

thomasalterman  Dengue is an arbovirus. The important hints are that she was traveling in endemic (tropical) and that she has **excruciating pain in the joints and muscles**. This is why dengue is aka "break-bone fever" +  
sam  Same vector +  
sam  Same vector +  




 +0  upvote downvote
submitted by thepacksurvives(5),

My thought was that this is endemic typhus from louse [on a cruise, rash only on the trunk, arthralgia]

Thoughts?

Honestly, even if it is dengue was the same answer shrug emoji

uslme123  I did too ... but It looks like the timing fits better for denge. +