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1.
Med-Challenger EM Career
Comprehensive Review and Assessment for
Practicing
Emergency Physicians
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Issue: May 1, 2007
Case: Tick-Borne Diseases
Taken from
Med-Challenger EM Career
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Question:
All of the following are considered clinical manifestations of
Lyme disease EXCEPT:
- Phase I: a distinctive circular spreading lesion occurs
in 85-90% (erythema chronicum migrans), with smaller
satellite lesions in many
- Phase I: about 50% have a syndrome of headache, malaise,
myalgias, fever and fatigue; conjunctivitis, periorbital
edema, facial rash, and diffuse erythema may occur, and
lymphadenopathy may be prominent
- Phase II: after weeks to months, transient cardiac (myopericarditis,
AV block) and neurologic abnormalities (cranial and
peripheral neuropathies, Bell's palsy, aseptic meningitis,
encephalitis) may occur
- Phase III: after months to years, mono- or oligoarticular
large-joint arthritis, arthralgias, or synovitis, possibly
chronic or recurrent in more than 50%; psychiatric disorders,
chronic fatigue, impaired memory, polyneuropathy, and
demyelinating disease have been reported
- Phase III: polyarticular arthritis, chronic or
recurrent, with progressive CNS degeneration
Answer:
E
Remediation:
The stages of Lyme disease are highly variable. Severe headache
and meningeal irritation may occur with the acute phase, but the
spinal fluid is usually negative.
About the Image(s):
Image 1:
Erythema Migrans
These large, red, nonscaling, and edematous plaques are
characteristic of Lyme disease. The plaque begins at the site of
the tick bite and expands, often with central clearing. The
central area can also become severely inflamed, bluish,
vesicular, or necrotic.
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