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Retired NBME 19 Answers

nbme19/Block 3/Question#4 (reveal difficulty score)
A previously healthy 18-year-old man develops ...
Lyme disease 🔍 / 📺 / 🌳 / 📖
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submitted by surgerydoctorca_sgu(6)
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This question is testing your knowledge on Lyme disease. The stem describes the patient as having a rash and flu-like illness 2 months ago, and now he is presenting with pain in multiple joints and fatigue. The stem is describing Stage 1 and 2 of Lyme disease.

  • Stage 1—early localized: erythema migrans (typical “bulls-eye” configuration B is pathognomonic but not always present), flu-like symptoms.

  • Stage 2—early disseminated: secondary lesions, carditis, AV block, facial nerve (Bell) palsy, migratory myalgias/transient arthritis.

There us also a Stage 3 which was not described in the stem:

Stage 3—late disseminated: encephalopathy, chronic arthritis, peripheral neuropathy.

Also, when it comes to treatment know that doxycycline is 1st line, and if you have a pregnant patient then you would prescribe amoxicillin or to patients who are under 8 years old. Additionally, IV ceftriaxone is required.

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