id q.4 - chapper

[ArchivalUser]

Testing for which of the below patients for borrelia burgdoferi is indicated (all of them reside in Lyme- endemic area)?

1.A 35 year old gardner with fever, malaise, migratory arthraligia/myalgias and 3 erythema migrans lesions.
2.A 18 year old house worker with a primary ertythema migrans lesion at the site of a witnessed tick bite.
3.A 25 year old camp counseller, who comes with her 2nd episode of an inflamed, red and tender knee and ankle joint.
4.A 40 year old park ranger with malar rash, diffuse arthritis/ arthrlagia( incl shoulders, MCP and PIP), glomerulonephritis & pericarditis.
5.A 50 year old male with chronic fatigue, myalgia and arthralagia.

[ArchivalUser]

4..

[ArchivalUser]

agree with hays

[ArchivalUser]

@ hays & stefan..wrong answer...

[ArchivalUser]

2,,

[ArchivalUser]

you don't do work up for tick bite it can be babesisois or erlichia only in pregnat women,immunocompromised or debilitating pt

[ArchivalUser]

il go for 5..

[ArchivalUser]

Ans is 3...


1. Lyme serology shud only be done in pts with an intermediate probability of having Lymes.
2. Both patients 1 & 2 have diagnostic Lyme’s disease. The diagnosis is entirely clinical.
3. Patient 4 clinical course looks like SLE and therefore iniotial lab tests shud focus on SLE.
4. Patients with chronic fatigue, myalgias and cognitive changes are concerened to have Lymes but the pre-test probability is very low, assuming the antescedent EM and a positive serology os unlikely to be true positive.
5. Arthrities due to Lymes normally occurs after mths from the initial infection and in approximately 60% of untreated cases. The typical attack is:

a. Large joint
b. Olioarticular.
c. Intermittent, lasting weeks at a time.