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NBME 24 Answers

nbme24/Block 4/Question#37 (29.8 difficulty score)
A male newborn is delivered in the hospital ...
Ingestion of undercooked meat🔍

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submitted by lsmarshall(394),
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"iAr lod"pters nsudos lkie rosepirayrt aivas(l ro trwe)a opredts.l altniahIno of moapolsaxt tyoscos ni cat ceesf sin't qeuit eht ;aems ont ot yas I owkn ytcalxe hawt teh yscosto are ldeanhi as (jtus ccimsoocirp rdy cat popo rla)sp.ecti? stInenogi of eorcnkouded meta ot egt eht tsycs si ltayercni a RTO orf osao.xaplmt

xsTopoalam as TOHCR sah atidr fo uo,hpyrhesdlac brcrelae acficstaniiolc ercr,(bnatiea)rl nda oinirtiri.eoscht chriinriteoitos acn eb ni netcnoailg CVM ro o.iopmoxsstasl nuerlaiirrtcevP oictncfcaalsii era ni VCM. neiglCnota MCV ayulsul ahs eranigh slos, usrzse,ei lceipheta rha,s bylure“ebr miffu”n ,shra ciii,rhtoosenrti dna rarveulinrtpcie onicasi.ctcailf

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. +1  
zevvyt  is his small head common is Toxoplasma? +  

submitted by andro(171),

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)

    submitted by majic(8),
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    HET SOTM MCOOMN rotue fo Txoo nassiosirmnt in ladsut ni the ASU si nitgsnieo of rdokueodenc p.ork vEne if cat leitrt is na ,itpoon orocukeednd rpok is tlsli remo m.noomc

    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 +  

    submitted by azibird(158),

    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 +