Lyme Disease

Question 1

Lyme disease is a multisystemic, tick-borne illness caused by the spirochete bacterium Borrelia burgdorferi, transmitted to humans primarily through the bite of infected Ixodes ticks. What is the incidence of Lyme disease?

1 - 1.2 cases per 100,000
2 - 12 cases per 100,000
3 - 120 cases per 100,000
4 - 1200 cases per 100,000

Answer 1

2 - 12 cases per 100,000

Equally as likely in males and females

The risk of transmission increases with the duration of tick attachment, with the highest risk occurring after 36-48 hours.

Question 2

Lyme disease is a multisystemic, tick-borne illness caused by which bacteria?

1 - Borrelia burgdorferi
2 - Rickettsia
3 - Aedes aegypti
4 - Plasmodium falciparum

Answer 2

1 - Borrelia burgdorferi

Transmitted to humans primarily through the bite of infected Ixodes ticks

Aedes aegypti = dengue fever
Plasmodium falciparum = malaria

Question 3

What age does the incidence of >yme disease peak at?

1 - 0-12 months
2 - 1-5 years
3 - 6-15 years
4 - 20-30 years

Answer 3

3 - 6-15 years

Question 4

Lyme disease is a multisystemic, tick-borne illness caused by Borrelia burgdorferi. Which of the following is NOT a common place where people can be infected by these ticks?

1 - wooded areas
2 - animals (horses, cats, dogs)
3 - ponds/lakes
4 - sports stadiums
5 - marshes/thick grass

Answer 4

4 - sports stadiums

This is why its important to ask about animal s

Question 5

Typically following the tick bite, how long is it before symptoms present?

1 - 5 mins to 5 hours
2 - 1-3 days
3 - 1-4 weeks
4 - 12-24 weeks

Answer 5

3 - 1-4 weeks

BUT can present as early as 3 days and up to 3 months

Question 6

When considering the pathophysiology, 70-80% of patients with Lyme disease can present with what?

1 - comjunctivitis
2 - erythema migrans
3 - lichen sclerosus
4 - discoid exzema

Answer 6

2 - erythema migrans

Characteristic bull’s-eye rash caused by host immune system reacting to the tick

Question 7

Patients with Lyme disease can present with erythema migrans, characteristic bull’s-eye rash. Which of the following is NOT true about erythema migrans?

1 - painless
2 - >5cm and can grow in size
3 - present in 70-80% of patients
4 - always develops as soon as patient is infected

Answer 7

Typically develops 1-4 weeks after the initial bite but may present sooner

Question 8

In addition to erythema migrans, patients can present with all of the following symptoms, EXCEPT which one?

1 - headache
2 - epistaxis
3 - lethargy
4 - fever
5 - arthralgia
6 - swollen glands

Answer 8

2 - epistaxis

Question 9

All of the following are late features of Lyme disease, EXCEPT which one?

1 - heart block and/or peri/myocarditis
2 - pneumonia
3 - facial nerve palsy
4 - radicular pain
5 - meningitis
6 - uveitis or keratitis

Answer 9

2 - pneumonia

Doesn’t typically affect the lungs

Question 10

Lyme disease can be diagnosed clinically, but what is the 1st line test that can be performed if required?

1 - ECG
2 - ELISA
3 - PCR
4 - ESR/CRP

Answer 10

2 - ELISA

According to NICE guidelines, this is done if patient does not have erythema migrans

Measures presence of antibodies to Borrelia burgdorferi

Negative: does NOT rule out Lyme disease, repeat ELISA in 4-6 weeks if high clinical suspicion

Question 11

The following are late features of Lyme disease:

• heart block and/or peri/myocarditis
• facial nerve palsy
• radicular pain
• meningitis

How long is it before the symptoms typically present?

1 - 24h
2 - 7 days
3 - 30 days
4 - 90 days

Answer 11

3 - 30 days

Question 12

How is Lyme disease typically diagnosed?

1 - ELISA
2 - PCR
3 - Swab
4 - Clinical diagnosis

Answer 12

4 - Clinical diagnosis

NICE advise that clinical diagnosis can be made if erythema migrans is present.

Question 13

What is the treatment of choice in a patient infected with Lyme disease who is asymptomatic?

1 - ceftriaxone
2 - acyclovir
3 - removal of ticks using tweezers
4 - doxycycline

Answer 13

3 - removal of ticks using tweezers

Once removed, wash the area

Question 14

What is the treatment of choice in a patient infected with suspected/conformed early Lyme disease?

1 - ceftriaxone
2 - acyclovir
3 - removal of ticks using tweezers
4 - doxycycline

Answer 14

4 - doxycycline
Amoxicillin if doxycycline is contraindicated

If patients has erythema migrans, antibiotics can be given with no further tests

Question 15

What is the treatment of choice in a patient infected with disseminated Lyme disease?

1 - ceftriaxone
2 - acyclovir
3 - removal of ticks using tweezers
4 - doxycycline

Answer 15

1 - ceftriaxone

Question 16

In a patient with Lyme disease, following treatment they can develop what?

1 - autoimmune haemolysis
2 - Jarisch-Herxheimer reaction
3 - necrotizing fasciitis
4 - anaphylaxis

Answer 16

2 - Jarisch-Herxheimer reaction

Flu like symptoms following administration of antibiotics, BUT no treatment required

More commonly seen in syphilis, another spirochaetal disease