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NBME 24 Answers

nbme24/Block 4/Question#9 (46.3 difficulty score)
A 10-year-old boy who was adopted from the ...
Black fly🔍

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submitted by brethren_md(82),
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orcncOhaec lslVouuv vai efmale k.llacfyb kclaB e,sifl lbkca kisn noeslu,d cb"lka "thgsi ak(a nsdn)Bs.ile nsueQtoi mtes here sbedcseir het abkcl esudlon sene in n.occeacOrh

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

submitted by madojo(133),


FLY GUY IN THE BACK Stains on the lab coat and pants --> black fly bites human host and the larvae burrow down into the host and make microfiliarial that come back out making hyper and hypopigmented spots. Human hand covering eyes --> causes river blindness Stray pink granules --> eosinophilia Microscope --> microfilaria on skin biopsy under microscope No dumping drains to river - Ivermectin for treatment

submitted by waterloo(58),

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 syoung07(11),

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 drmomo(17),
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hyw atc'n ti eb lcuxe ?oqmouist ymabe errechauiw aoctnbifr ?rafiiislas

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 linwanrun1357(6),

NOTE: Microfilaria:

Microfilariais an early stage in the life cycle of certain parasitic nematodes in the family Onchocercidae.--wiki

linwanrun1357  Only the the black fly is associated with nematodes +  

submitted by tyrionwill(10),

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 famylife(82),
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