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Week 21

 

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Quiz 21 Context:

A 28-year-old male presents in late June with the complaint of low grade fevers, headaches, and malaise of recent onset following his return from a camping and hiking trip in northern California the previous week. The patient reports that he consumed only commercially packaged food and water during the trip. He denies any previous illness or chronic medical conditions. He does not recall any trauma during the trip.

Physical examination reveals a male patient in no distress. Vital signs reveal a temperature of 38.0 degrees Celsius, heart rate 75 bpm, blood pressure of 110/70. The HEENT, cardiac, pulmonary, abdominal, and neurologic exams are all unrevealing. Examination of the skin is notable for a new skin rash. The patient believes the rash has enlarged.

The skin rash is shown above.

This history and examination are most consistent with which of the following possibilities:

  1. Subacute bacterial endocarditis
  2. Lyme disease
  3. Q Fever
  4. Tularemia
  5. Syphilis

 

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Center for Continuing Education | 9500 Euclid Avenue, KK31, Cleveland, OH 44195