q7 - kola

[ArchivalUser]

1]A 45-year-old physician who has recently returned from an early summer fishing vacation (Physician? Vacation? Sounds like an oxymoron.) in rural North Carolina presents for a febrile illness. He reports a 5-day history of fever, malaise, headache, and vomiting. Today he has developed a maculopapular eruption that began on his extremities and has spread to his body. It involves his palms and soles and is nonpruritic.

The most likely diagnosis is:

A) Chicken pox.

B) Syphilis.

C) Parvovirus.

D) Rocky Mountain spotted fever.

E) Human monocytic ehrlichiosis.


2]What is the appropriate treatment for this patient?

A) Obtain serologic studies and treat symptoms with nonsteroidal antiinflammatory agents.

B) Penicillin VK 500 mg PO TID for 14 days.

C) Levofloxacin 500 mg IV q 24 hours for 10 days.

D) Admit to the hospital and begin IV ceftriaxone 1 gram q 24hours until fever has resolved.

E) Doxycycline 100 mg PO BID for 14 days.

[ArchivalUser]

d
e

[ArchivalUser]

d and e?

[ArchivalUser]

exactly d,e

Early treatment is essential. Individuals treated after 5 days of symptoms have poorer outcomes than those treated earlier. Awaiting serologic studies is inappropriate and treatment should not be delayed. The drug of choice in the treatment of RMSF is doxycycline. Pregnant women should be treated with chloramphenicol. Agents such as penicillin, fluoroquinolones, and cephalosporins are inappropriate in this situation.

. Rocky Mountain spotted fever (RMSF) is a tick-borne (dog or wood tick) disease caused by Rickettsia rickettsi. It presents with a prodrome of fever and headache several days before the onset of the characteristic rash-a maculopapular eruption that begins at the wrists and ankles and spreads centrally. It occurs in the spring and early summer months and is endemic in the southeastern U.S., the Atlantic states, and the northern Rocky Mountains. Answer A is incorrect. Chicken pox, usually a disease of childhood, is characterized by a pruritic vesicular rash that occurs in crops. Older patients with a history of prior infection develop herpes zoster (shingles) and present with a vesicular rash in a dermatomal distribution and few other systemic symptoms. Answer B is incorrect because the secondary stage of syphilis is characterized by a generalized maculopapular rash, which affects the palms and soles, and is not associated with systemic symptoms. Answer C is also incorrect. Human parvovirus B19 (fifth disease) is a disease of childhood. The rash has been described as a slapped cheek appearance. Finally, E is incorrect. Human monocytic ehrlichiosis is typically not accompanied by a rash, which is why it is sometimes called "Rocky Mountain spotless fever". The disease is tick-borne and endemic to midwestern, south central, and southeastern states. It is caused by Ehrlichia chaffeensis.