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NBME 27 Answers

nbme27/Block 1/Question#37 (reveal difficulty score)
A 19-year-old woman comes to the physician ...
Yersina pestis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: Yersinia_pestis

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submitted by โˆ—shak360(14)

Yersinia pestis is commonly found in the southwestern USA, which is also a place that we associate with infection by Coccidiomycosis. In the question, she is from a small farm in rural New Mexico. Furthermore, though we associate Yersinia pestis with rats and the Bubonic Urban plague, the main vector is the flea. The Sylvatic plague form of Yersinia pestis is often carried by domestic cats, but the vector still remains as the flea (as noted in this question). The main symptom of Yersinia pestis infection is the presence of high fever and painful buboes, extremely large lymphatic swellings in the groin or in the axilla (armpit). Treatment is with aminoglycosides or doxycycline.

Francisella tularensis is a fastidious gram-negative bacterium that causes tularemia and much like Yersinia, can also present as a ulceroglandular disease acquired through contact with infected animals (often rabbits, hence the name "Rabbit fever' or "Beaver fever"). Common symptoms include a local eschar at the site of entry and lymphadenopathy. Also like Yersinia, Tularemia can also present as a pneumonic form, causing dry cough, pleuritic chest pain, and ARDS, and is often lethal. Much like Yersinia, it can also be found in the Southwest to Midwest USA but is transmitted via ticks, and as mentioned before, via small animals.

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