CLIN MED III – INFECTIOUS DISEASES EXAM 3
STUDY GUIDE (EXCLUDES PUBLIC HEALTH &
COUNSELING
1. What are helical, corkscrew-shaped, motile gram-negative bacteria that use
endoflagella for movement through tissues?
➡️Spirochetes
Examples: Borrelia burgdorferi (Lyme disease) and Treponema pallidum
(syphilis).
2. What antibiotics are used to treat spirochete infections?
➡️Penicillin (PCN) or Doxycycline
3. Which stage of Lyme disease presents with erythema migrans and may include
viral-like symptoms (fever, fatigue, headache, myalgia)?
➡️Early Localized Stage
4. What symptoms can occur during the early disseminated stage of Lyme disease?
➡️Multiple erythema migrans lesions, facial nerve palsy, meningitis,
radiculoneuritis, or carditis.
5. What clinical sign of Lyme disease can be diagnosed without laboratory
confirmation?
➡️Erythema migrans (serologic tests may be negative early on)
,6. How long must a tick remain attached to transmit Borrelia burgdorferi?
➡️36–48 hours (most cases occur between May and September)
7. When should Lyme serologic testing be performed?
➡️Only when disseminated or late-stage Lyme disease is suspected and the
patient has a history of possible exposure. (Mnemonic: STOMP)
8. What is the standard two-tier algorithm for Lyme laboratory diagnosis?
➡️Initial enzyme immunoassay (EIA) → if positive, confirm with IgM and IgG
immunoblots.
9. What diagnostic tests are performed for Lyme-related complications?
Arthritis: PCR on synovial fluid
Meningitis: CSF analysis
Carditis: ECG monitoring
10. What is the first-line therapy for adults with Lyme disease?
➡️Doxycycline 100 mg PO twice daily for 10 days
Alternative (pregnant): Amoxicillin 500 mg PO three times daily for 14 days or
Cefuroxime axetil 500 mg PO twice daily for 14 days.
,11. Treatment for Lyme with mild systemic symptoms or facial palsy?
➡️Doxycycline 100 mg PO twice daily for 14–21 days
For meningitis or radiculopathy:
➡️Ceftriaxone 2 g IV daily for 14–21 days
12. Management for Lyme carditis with PR interval >300 ms or heart block?
➡️Admit for continuous telemetry; start Ceftriaxone 2 g IV daily for 14–21 days,
then transition to PO doxycycline once stable.
13. Initial treatment for Lyme arthritis?
➡️Doxycycline 100 mg PO twice daily for 28 days
If symptoms persist: repeat oral course or switch to Ceftriaxone 2 g IV daily for 2–
4 weeks.
14. Post-exposure prophylaxis for Lyme disease?
➡️Doxycycline 200 mg PO single dose
Syphilis
15. Describe the stages of syphilis:
, Primary: Painless, firm chancre at inoculation site with regional lymphadenopathy
(10–90 days post exposure).
Secondary: Diffuse maculopapular rash (palms/soles), condyloma lata, mucous
patches, and generalized lymphadenopathy (4–10 weeks after chancre).
Latent: Positive serology without symptoms (early <1 year; late >1 year).
Tertiary: Gummatous lesions, cardiovascular syphilis, or neurologic complications
(tabes dorsalis, general paresis), developing years later.
16. At what stage can neurosyphilis occur?
➡️At any stage, especially in patients with neurologic, ocular, or otologic
symptoms.
17. Which spirochete cannot be cultured on artificial media?
➡️Treponema pallidum
18. What is the hallmark lesion of primary syphilis?
➡️Painless indurated ulcer with clean base and defined borders—commonly on
the genitalia.
19. What areas are typically affected by the rash of secondary syphilis?
➡️Palms and soles
STUDY GUIDE (EXCLUDES PUBLIC HEALTH &
COUNSELING
1. What are helical, corkscrew-shaped, motile gram-negative bacteria that use
endoflagella for movement through tissues?
➡️Spirochetes
Examples: Borrelia burgdorferi (Lyme disease) and Treponema pallidum
(syphilis).
2. What antibiotics are used to treat spirochete infections?
➡️Penicillin (PCN) or Doxycycline
3. Which stage of Lyme disease presents with erythema migrans and may include
viral-like symptoms (fever, fatigue, headache, myalgia)?
➡️Early Localized Stage
4. What symptoms can occur during the early disseminated stage of Lyme disease?
➡️Multiple erythema migrans lesions, facial nerve palsy, meningitis,
radiculoneuritis, or carditis.
5. What clinical sign of Lyme disease can be diagnosed without laboratory
confirmation?
➡️Erythema migrans (serologic tests may be negative early on)
,6. How long must a tick remain attached to transmit Borrelia burgdorferi?
➡️36–48 hours (most cases occur between May and September)
7. When should Lyme serologic testing be performed?
➡️Only when disseminated or late-stage Lyme disease is suspected and the
patient has a history of possible exposure. (Mnemonic: STOMP)
8. What is the standard two-tier algorithm for Lyme laboratory diagnosis?
➡️Initial enzyme immunoassay (EIA) → if positive, confirm with IgM and IgG
immunoblots.
9. What diagnostic tests are performed for Lyme-related complications?
Arthritis: PCR on synovial fluid
Meningitis: CSF analysis
Carditis: ECG monitoring
10. What is the first-line therapy for adults with Lyme disease?
➡️Doxycycline 100 mg PO twice daily for 10 days
Alternative (pregnant): Amoxicillin 500 mg PO three times daily for 14 days or
Cefuroxime axetil 500 mg PO twice daily for 14 days.
,11. Treatment for Lyme with mild systemic symptoms or facial palsy?
➡️Doxycycline 100 mg PO twice daily for 14–21 days
For meningitis or radiculopathy:
➡️Ceftriaxone 2 g IV daily for 14–21 days
12. Management for Lyme carditis with PR interval >300 ms or heart block?
➡️Admit for continuous telemetry; start Ceftriaxone 2 g IV daily for 14–21 days,
then transition to PO doxycycline once stable.
13. Initial treatment for Lyme arthritis?
➡️Doxycycline 100 mg PO twice daily for 28 days
If symptoms persist: repeat oral course or switch to Ceftriaxone 2 g IV daily for 2–
4 weeks.
14. Post-exposure prophylaxis for Lyme disease?
➡️Doxycycline 200 mg PO single dose
Syphilis
15. Describe the stages of syphilis:
, Primary: Painless, firm chancre at inoculation site with regional lymphadenopathy
(10–90 days post exposure).
Secondary: Diffuse maculopapular rash (palms/soles), condyloma lata, mucous
patches, and generalized lymphadenopathy (4–10 weeks after chancre).
Latent: Positive serology without symptoms (early <1 year; late >1 year).
Tertiary: Gummatous lesions, cardiovascular syphilis, or neurologic complications
(tabes dorsalis, general paresis), developing years later.
16. At what stage can neurosyphilis occur?
➡️At any stage, especially in patients with neurologic, ocular, or otologic
symptoms.
17. Which spirochete cannot be cultured on artificial media?
➡️Treponema pallidum
18. What is the hallmark lesion of primary syphilis?
➡️Painless indurated ulcer with clean base and defined borders—commonly on
the genitalia.
19. What areas are typically affected by the rash of secondary syphilis?
➡️Palms and soles
