how do you tell the mother about it? - fellow

[ArchivalUser]

A 7-year-old female with no past medical history, presents to the emergency room complaining of fever and a rash for 8 weeks. According to the mother, the patient was doing well until 8 weeks ago when she developed a fever (up to 103Fahrenheit) with a rash. The rash began on the left flank and then spread to all areas of the body. It was erythematous and intermittently pruritic - usually at night. At that time, the patient was seen by the Primary Medical Doctor who diagnosed Fifth's disease. The patient was sent home with supportive treatment but symptoms continued to persist. The mother states that the patient is afebrile during the day and gets fevers and chills at night. The rash becomes more prominent when the child is febrile.
Two weeks later the child begins complaining of joint pain of the left knee and wrist with stiffening. The child cannot do normal daily activities and she is "wiped out" in the evening hours. There is no nausea, diarrhea, vomiting, or allergies. Her vision is normal and she denies dysuria. The only significant findings on the physical exam are a temperature of 99 Fahrenheit (37.2celsius) and a 'fingertip' spleen. A diffuse macular rash (each macule is pink and about 7millimetres in diameter) which is non-pruritic and non-papular is noted at the time of the exam. It is evident on the torso, abdomen, and extremities and sparing the palms and soles. The mother requests that her child be tested for Lyme disease.
Refer to the case. Your best response to the mother's request is
a A Lyme titer will probably be negative because Lyme disease is not the diagnosis
b It is possible that your daughter has Lyme disease and we will work this up along with some other possible conditions that might explain her symptoms
c The diagnosis is juvenile Rheumatoid Arthritis and the Lyme titer would probably be negative
d Your daughter does not fit the correct age group for the diagnosis to be Lyme disease
e Your daughter does not fit the correct age group for Lyme disease but we will do a Lyme Titer to be sure

[ArchivalUser]

answer is b

[ArchivalUser]

humas is right according to the answer key

[ArchivalUser]

I THINK IT IS STILLS DZ, MACULOPAPULAR RASH, COMES WITH FEVER, GOES WITH FEVER,
I THINK ITS A.

[ArchivalUser]

aspirin, this is just the way to response to patient's q. without any Dx test done, only more likely or unlikely. You can't say lyme is not the diagnosis, even you know it is very unlikely.

[ArchivalUser]

b It is possible that your daughter has Lyme disease and we will work this up along with some other possible conditions that might explain her symptoms