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NBME 24 Answers

nbme24/Block 4/Question#41 (reveal difficulty score)
A 30-year-old man who is a migrant farm ...
Formation of hypnozoites πŸ” / πŸ“Ί / 🌳
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 +25 
submitted by βˆ—someduck3(64),
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Fta usboell nmsiitav aer ,.EKA,D, oS obth D pm&a; E ocldu be sededcare in hits tp. Btu yuo ehav ot nokw htta itVimna E ecfideincy is tacdossiea itwh inyleeotidmna a;&pm sha neeb odtscasiae wtih tprroeiso lunomc dnme.itaonylie sAlo tiV E can be nveig thiw zAlheermi psatiten sa it hslep thiw eref sc..aliard?


 +16 
submitted by βˆ—jejunumjedi(30),
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eTh olobd semra cstpied Snfrefuhc sit.pniglp nudFo hte acetx mieag no the wbe tiwh einxpa:oantl

/ip:s2//a./it/xpvtt/o.ehdcvselg_tc.iheu~bsmcptial4_aepme.ro/vsp/Pb23/ja

doctorboomboom  Hey thanks for finding the image! Do you know why the answer can’t be Chloroquine resistance? I was b/w that and formation of hypnozoites. +6  
jejunumjedi  I think it's just that Schuffner stippling and hypnozoites are both specific to vivax and ovale species. These species could be chloroquine resistant or sensitive, but if you have Schuffner stippling or hypnozoites, you can definitively say that it's either vivax or ovale. +3  
sherry  Species with hypnozoites is not called chloroquine resistant. Chloroquine-resistant species means trophozoite/schizont cant be killed by chloroquine. We dont have enough info to decide whether the spp in the q is resistant/sensitive. But we do know he moved from Honduras to USA 1 year ago. +3  
soph  UW: in africa most malaria species are resistant to chloroquine. he is from hondruas +6  
randios  Can anyone explain the 1-week history of fever? Ruled out vivax and ovale due to 48 hr cycles. Or did they just throw that in as an unspecific symptom. +2  
dr_ligma  unspecific symptom probably +  
mcm94  how I know that is an infection by vivax/ovale ? if there's nothing that says about tertian fever? +3  
medguru2295  While it COULD be Chloroquine resistant, its not likely. This patient is likely infected with Vivax or ovale (not Falciparium) why? 1. Honduras (Falcip would be Africa) 2. Sx 1 year later (Liver form Vivax or OVale) 3. As many mentioned, Schuffer bodies Falciparium tends to be the species resistant to Chloroquine. Typically, Chloroquine is given for Vivax & Ovale (typically with something else- Atovaquone, Dapsone etc) to cover Liver Falciparium (no Liver form) is generally Chloroquine resistant (B) and therefore covered with Atovaquone/Proguanil. You do need 8-14 days of tx after coming for Falcip bc it can remain in the Liver for a few days (just not a dormant hypno form). To cover the "week of fever" question- its re-emergence of her sx. They probably just did not want to say cyclic to make it trickier. +5  
flvent2120  Looks like it's been touched on, but you could answer this solely based on the fact that it's been one year since living in Honduras. While it MAY be chloroquine resistant, it IS dormant. Test taking skills would be to choose the answer you can't argue with +  
meryen13  @doctorboomboom I think because its showing that its been a year since he immigrated ( late showing of the dz) its hinting toward the hypnotizes. not sure. +  



 +12 
submitted by βˆ—suckitnbme(223),
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vEne if yuo t'nca teertripn het bodlo r,esma htis ipnteta is esegnrinpt htwi maalria retaf gbine in het US ofr y1-ear. sI't iyhlhg knulelyi htat he tgo wlnye tidfeecn lhwei ni het SU. ahtW si grrconuci si a atoctainervi of antomdr aamirla ztypnehso(oi ni hte )elriv taht hits udde tgo hilwe ni aons.dHru

As schu this si iaslpmudmo aaovevx/lv.i aWht bporabyl denehppa saw hatt isth eattnpi was adteret twih heucorlionq wneh eh aws tiaiilnyl tceeif.nd hTis lowdu rleac hte nenificto in teh m,botalosder tbu osed ont ikll hte esznhptoioy in eth .rvlie tntmaTree twhi nqieairump si enedde to elcra teh enizohytpso, whihc ihts ttipnae kleyli idd ont eciever, eehcn arilaam ewlih in het S.U




 +7 
submitted by leny123(7),
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areeGln leru - irqoneoChul tisnevsie fi mrof neCabiarb or Cnetalr irecaAm wste of naaamP naC,la tsih iptaent immitgadre ormf snHourda os uyo cna liineamte lucheonroqi snareecist sa na neawrs chioec (in oidndtia to hte vil/evaavxo fion eo)bav.

charcot_bouchard  Guys along with all intelligent discussion also keep in mind he immigrated 1 year back. So it must be hypnozoites which is causing this because Murica is Malaria free. +28  



 +1 
submitted by βˆ—nwinkelmann(350),
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uoFnd this aertg oncteumd wtih dlessi tboau eth nteidreff gno:phstae 1i.atcgsr1/rS/2P9gbiSdg.-2p_nca_sn:/efoGthhpn0rpcrms9/0amrnea0p3/ttip




 +1 
submitted by βˆ—yotsubato(1152),
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idKn fo ticykr .quintseo eTh eotiznophsy era ncihroqlueo tssiratn.e utB teh pesscei may ont b.e

P. icaurplmFa si tsaesrnit and oklos keil a aabna,n utb you dont knwo if eht raaailm ni hte RCB is aaulcrmfip or tn.o

tyrionwill  whether resistant or sensitive, depends on the region, not on the species falci coming from Hatii could be sensitive +  



 +0 
submitted by βˆ—unknown001(2),
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EUOESRCR : CCD iraaMla cie:spes P. ivaxv 3%,9 P. auplircmfa 7.%

WHY ZPYHYENOSO ? 2 onasrse

  1. hernfsufc nsptpliig ( ahtt iedrw lecl thiw lsto of bule itrsl)gte

  2. HUASNDRO ( 39 enetprc are a)vxvi

unknown001  https://wwwnc.cdc.gov/travel/destinations/traveler/none/honduras +  



 +0 
submitted by βˆ—paperbackwriter(148),
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Pg. 571 of 2019 FA itucerp B sitcdpe fSehfurn nitsipplg rnued la.raaiM "Seen whti P aoxvaelvvi/"




 +0 
submitted by βˆ—krewfoo99(114),
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I thkni eucoirlhqno tcssaierne wont eb fsccipee ot xivva and uas,levoth akmgni ti the cctierorn asrenw. iheoColnurq ssarcetien cna papyl ot .P alipFcmaur nad .P aMaierla

lyOn ivavx dna veaol eascu nzioeyopth shut naimgk atht teh mero cealr nwsera




 +0 
submitted by βˆ—nwinkelmann(350),
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oDes eynoan nkow owh to reul tuo E? I'ev envre edlnear aobut nsmisirocgmaro fyipcslciael atgncvitia a slc'le Cs,MA tub nweh I loodek ti ,up I ondfu ihst cleatir (ib:plttm3cgwohi..C3Manwpc.wn.ssi/7/9/c/v5elPth/mr/n0). ehT riaclet tsnd'oe sieayclplcif tnmoein mupimaodls as ugsni ,it tub evrsela of eht ucreosesr rfo het raectil ds.oe




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