QBDOTW: A 39-year-old Male Living in Honduras
Welcome to MedSmarter’s USMLE Style Question Break Down of the Week for those preparing for your USMLE Step 1. Today we have the breakdown of a high-yield Microbiology question. As always you want to begin with reading the last sentence of the vignette first to get an understanding of what the question is asking for.
Question Break Down of the Week:
A 39-year-old man living in Honduras presents to a clinic complaining of constipation and stomach pains for several months. On cardiac examination, the physician discovers a laterally displaced point of maximal impact. Chest and abdominal x-rays reveal pulmonary congestion, cardiomegaly, and megacolon. Symptomatic treatment is all that can be offered to the patient. What insect is the most likely route of transmission for this patient’s illness?
A) Anopheles mosquito
B) IIxodes tick
C) Reduviid bug
D) Sandfly
E) Tsetse Fly
The correct answer choice is C: This patient is presenting with Chagas’ disease, which is caused by infection with Trypanosoma cruzi. Chagas’ disease is mostly transmitted by the reduviid bug in Central and South America. Acute symptoms include chagomas (small dermal granulomas caused by local multiplication of the pathogen), myocarditis, and congestive heart failure as a severe, but rare, complication of myocarditis. More chronic symptoms include arrhythmias, dilated cardiomyopathy, megacolon, and megaesophagus.
Did you think the answer was different?
Did you think that the correct answer choice was other than C? For a deeper discussion of why A, B, D, and E were not the correct answer choices, you can view this video.
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