****************3 - fexofenadine

[ArchivalUser]

A 29-year-old man develops a fl u-like illness 10
days after a trip to upstate New York. On physical
examination, he has lymphadenopathy and
a circular, nonpruritic, erythematous, macular
rash on his left arm. One red spot is particularly
big and has a clear area in the center.
Which of the following statements is correct?

(A) A diagnosis of late stage Lyme disease is
best made based on clinical presentation
(B) Erythema multiforme is the characteristic
rash of Lyme disease
© Lyme disease is best treated with a fl uoroquinolone
(D) The late stage, stage 3, of Lyme disease is
characterized by acute, aseptic meningitis
(E) The reservoir of Borrelia burgdorferi is the
white-footed mouse

[ArchivalUser]

eee

[ArchivalUser]

ccc

[ArchivalUser]

EEEEEEEE

[ArchivalUser]

The correct answer is E. The white-footed
mouse is the main reservoir of Borrelia burgdorferi.
The bacterium is spread to humans by
the Ixodes tick. Lyme disease has three characteristic
stages. Stage 1 is characterized by erythema
chronicum migrans (ECM), arthralgias,
and nonspecifi c fl u-like symptoms. Stage 2 is
marked by the appearance of multiple small
ECM rashes, as well as cardiac and neurologic
involvement. Stage 3 involves arthritis, usually
of the large joints, and chronic, progressive
central nervous system disease.
Answer A is incorrect. Early, localized Lyme is
more reliably diagnosed clinically (i.e., on the
basis of a tick exposure and rash) due to the delay
in the development of antibodies. Serologic
tests for Lyme are, however, particularly helpful
in evaluating patients for the later stages of
Lyme disease.
Answer B is incorrect. Erythema chronicum
migrans is the characteristic rash of Lyme disease.
It is a circular, macular rash with a clear
center that spreads out over time.
Answer C is incorrect. Lyme disease can be
treated with doxycycline or any antibiotic from
the penicillin family.
Answer D is incorrect. Stage 2, not stage 3, of
Lyme disease is characterized by neurologic
involvement, including aseptic meningitis and
cranial neuropathies, such as Bell™s palsy.

[ArchivalUser]

cool