NBME 24 Ingestion of undercooked meat (NBME Answers)

Retired NBME 24 Answers

nbme24/Block 4/Question#37 (reveal difficulty score)
A male newborn is delivered in the hospital ...
Ingestion of undercooked meat 🔍 / 📺 / 🌳 / 📖
tags: infectious_disease TORCH

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submitted by ∗andro(269)

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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)

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ih8payingfordis Toxoplasma gondii FA 2019 pg 156 +

jbrito718 Its so fascinating how similarly congenital toxo vs CMV present +1

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submitted by ∗lsmarshall(465)

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"Air droplets" sounds like respiratory (saliva or water) droplets. Inhalation of toxoplasma oocysts in cat feces isn't quite the same; not to say I know exactly what the oocysts are inhaled as (just microscopic dry cat poop particles?). Ingestion of undercooked meat to get the cysts is certainly a ROT for toxoplasma.

Toxoplasma as TORCH has triad of hydrocephalus, cerebral calcifications (intracerebral), and chorioretinitis. chorioretinitis can be in congenital CMV or toxoplasmosis. Periventricular calcifications are in CMV. Congenital CMV usually has hearing loss, seizures, petechial rash, “blueberry muffin” rash, chorioretinitis, and periventricular calcifications.

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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? +

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submitted by majic(12)

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THE MOST COMMON route of Toxo transmission in adults in the USA is ingestion of undercooked pork. Even if cat litter is an option, undercooked pork is still more common.

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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 +

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submitted by ∗azibird(279)

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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.

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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 +

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submitted by ∗unknown001(9)

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tip to diff. cmv vs toxoplasmosis cns findings.

cmV= periVentricular calcifications.

Toxoplasmosis= intracranial calcifications

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submitted by ∗namesthegame22(14)

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DDX:

Mom with hx of occipital LAD = Rubella infection in a pregnant patient increases the risk for congenital rubella infection, which characteristically presents with cataracts, sensorineural deafness, and congenital heart disease (eg, patent ductus arteriosus) in the newborn, as well as microcephaly, neurodevelopmental delay, and extramedullary hematopoiesis.

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