USMLE Forum Archives - USMLE Step 2 CK - IM 50
IM 50
TheOne - 08-04-07 17:21
A 25 years old man returns to the clinic for further evaluation of bilateral facial weakness and radicular arm pain. For the past few weeks he has suffered progressive facial palsy on both sides of her face and hyperacusis and dry eyes. On his previous visit, he described a 2-week history of low-grade fever, headache, mild neck stiffness, and photophobia. Review of systems revealed a recent rash that had developed after a camping trip, and then, after expanding outward from the sight of a small tick bite, resolved spontaneously. A lumbar puncture was performed at that time, and revealed the following:
Cerebrospinal fluid
Cell count 62 cells/mm3
Cell count differential 10% neutrophils, 80% leukocytes, 8% monocytes
Protein 100 mg/dL
Glucose 52 mg/Dl
An increased amount of immunoglobulin was present with two oligoclonal bands on analysis. Cerebrospinal fluid (CSF) also was sent for PCR analysis of Borrelia burgdorferi, while peripheral blood samples were sent for antibody analysis. Today the results are available. The CSF analysis and the peripheral blood samples are positive for Borrelia burgdorferi. Which of the following is the most appropriate treatment for this patient’s condition?
A. Intravenous acyclovir and corticosteroids
B. Intravenous interferon and corticosteroids
C. Intravenous penicillin
D. Oral minocycline or erythromycin
E. Oral sulfamethoxazole/trimethoprim
TheOne - 08-04-07 17:21
A 25 years old man returns to the clinic for further evaluation of bilateral facial weakness and radicular arm pain. For the past few weeks he has suffered progressive facial palsy on both sides of her face and hyperacusis and dry eyes. On his previous visit, he described a 2-week history of low-grade fever, headache, mild neck stiffness, and photophobia. Review of systems revealed a recent rash that had developed after a camping trip, and then, after expanding outward from the sight of a small tick bite, resolved spontaneously. A lumbar puncture was performed at that time, and revealed the following:
Cerebrospinal fluid
Cell count 62 cells/mm3
Cell count differential 10% neutrophils, 80% leukocytes, 8% monocytes
Protein 100 mg/dL
Glucose 52 mg/Dl
An increased amount of immunoglobulin was present with two oligoclonal bands on analysis. Cerebrospinal fluid (CSF) also was sent for PCR analysis of Borrelia burgdorferi, while peripheral blood samples were sent for antibody analysis. Today the results are available. The CSF analysis and the peripheral blood samples are positive for Borrelia burgdorferi. Which of the following is the most appropriate treatment for this patient’s condition?
A. Intravenous acyclovir and corticosteroids
B. Intravenous interferon and corticosteroids
C. Intravenous penicillin
D. Oral minocycline or erythromycin
E. Oral sulfamethoxazole/trimethoprim
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#2
lyme dz lakreol - 08-13-07 16:37 tetracycline- was spit out answer
so doxycycline - demeclocycline, minocycline
let me know :huh:
erythromycin is a macrolide so it's a diffrent class as apposed to tetracycline - i went to check in the first aid
#3
Re: IM 50 bazigar - 08-15-07 05:20 Answetr is IV penicillin.DOC for Lyme s disease with neuro complication is IV Ceftriaxone then second choice is cefotaxime and third is penicillinIV. Also spirchetes responds well to penicllins
#5
Re: IM 50
TheOne - 09-03-07 16:35 The correct answer is C. Lyme neuroborreliosis can present with a variety of neurologic findings. The most common findings are radicular pain and facial paralysis that can be unilateral or bilateral. Appropriate treatment for this condition requires prolonged parenteral antibiotics to ensure adequate penetration of the blood-brain barrier.
Intravenous ceftriaxone and penicillin G are two commonly used agents. Oral agents, such as minocycline, erythromycin (choice D), or sulfamethoxazole/trimethoprim (choice E) are not appropriate in the light of neurologic findings.
Acyclovir and corticosteroids (choice A) sometimes are prescribed empirically for Bell's palsy, as herpes simplex virus (HSV) is believed to be a common cause of the condition. It is not appropriate for bilateral facial paralysis or in any case in which Lyme disease is suspected.
Interferon and corticosteroids (choice B) are used for the treatment of multiple sclerosis. Oligoclonal bands are seen in MS, but are notoriously nonspecific for the condition, as any demyelinating process can cause them.
#7
Re: IM 50 babbu5508 - 07-07-10 00:29 C. Intravenous penicillin
neurological problems with lyme's disease include facial palsy, which is the loss of muscle tone on one or both sides of the face, as well as meningitis, which involves severe headaches, neck stiffness, and sensitivity to light.
#8
Re: IM 50 bingousmle - 07-07-10 01:12 C. Intravenous penicillin
though i would have gone for ceftriaxone intaveonus if it were there in the choices according to MTB
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