sing
Forum Guru
Topics: 153
Posts: 370
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Q.
a female has fever, headache, photophobia and mild slurred speech for 2 days.
pe: t, bp, p, rr are all normal, but has mild facial droop.
history: she went camping in upstate new york 3 wks ago and was bitten by a tick and got a rash with central area of clearing on the biting site.
which is the most appropriate next management.?
1. lumbar puncture
2. intravenous ceftriaxone
3. oral doxycycline
4. get serum lyme ab titer
5. serum lyme pcr
A & Y?
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| YA ALI MADAD
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what i got from CMD 2003 ..
in our case...we r not waiting for the diagnosis..the patient is giving a history of a tick bite and the rash is typical of Lyme disease..! from this ...we kick out choices 4 and 5!
if meningitis is present, ( which is present in this case...fever, photophobia..etc tells it all) .....intravenous ceftriaxone is to be given..!
lumbar puncture...well....we cant wait for it.! ...the patient is already showing signs of meningitis.>! NOT MY CHOICE
last....regarding doxycycline..! ( CMD says that even without treatment , the symptoms and signs of erythema migrans resolve in 3-4 weeks)....MIND U....she has came 3 weeks after>
so my choice is : 2. intravenous ceftriaxone
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| sing
Forum Guru
Topics: 153
Posts: 370
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hi, ya ali madad, thanks a lot for your answer. i agree with you. my answer was "intravenous ceftrixone" as well.
however, the answer from kaplan qbank is "lumpar puncture" since "we need know definitely that the patient is central nerve system involvement or isolated bell palsy." i am not convinced by this explanation.
if anyone has different opinion, pls let me know. thanks.
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| no more a loser
Forum Guru
Topics: 140
Posts: 580
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hey i think the made the answer 'lumber puncture' first step cuz anyone (doesnt matter how clear the etiology is) with clinical suspicion of meningitis should get a lumber puncture n then u start them on ceftriaxone, ampicillin, vancomycin & acyclovir till cultures r pending
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