syphillis and lyme

Question 1

spirochetes

Answer 1

thin + helical, gram-negative, cork screw motility

Question 2

organism causing syphillis

Answer 2

treponema pallidum

Question 3

primary syphilis

Answer 3

chancre at site of inoculation (genitals, mouth, eyes) + painless lymphadenopathy

lasts 1-6 weeks

Question 4

secondary syphillis

Answer 4

generalized rash (red, not itchy, entire body - starts at trunk and spreads)

highly infectious

Condyloma lata (look like genital warts)

Can have flu-like symptoms

Question 5

latent syphilis

Answer 5

asymptomatic, + test

early: <1 year
later: >1 year

Question 6

tertiary syphilis

Answer 6

diffuse chronic inflammatory state

Question 7

tertiary cardiovascular syphilis

Answer 7

endarteritis obliterans (vaso vasorum) –> ascending aortic aneurysm

Question 8

tertiary syphilis - gumma

Answer 8

granulomatous lesions filled with immune cells + necrotic center
can affect bone, mouth, liver, etc

leads to organ damage, hepatitis, fractures

Question 9

neurosyphilis

Answer 9

can spread via blood to brain

meningitis, cranial nerve palsy, meningovascular –> stroke

Question 10

dark field microscopy

Answer 10

can take exudate from lesion and view under microscope

need motile spirochetes

can get false positive from oral lesions

Question 11

non-treponemal serology

Answer 11

VDRL: venereal disease research lab (CSF)

RPR: rapid plasma reagin (blood)

non-specific antibodies to cardiolipin

Question 12

treponemal serology

Answer 12

specific antibody tests against treponemal cellular components

Fluorescent treponemal antibody absorption (FTA-ABS)

Micro hemaggluutination test for antibodies to T. pallidum (MHA-TP)

T. pallidum particle agglutination assay (TPPA)

T. pallidum enzyme immunoassay (TP-EIA)

Chemiluminescence immunoassay (CIA)

Question 13

false positive w/non-treponemal

Answer 13

viral infection, rheumatoid arthritis, SLE, pregnancy, malaria, leprosy, TB, HIV, etc

Question 14

false positive w/ treponemal

Answer 14

autoimmune disease, IVDA, fever, age, lyme, endemics syphilis, leprosy

Question 15

congenital syphillis

Answer 15

based via placenta or vagina

can cause fetal death

if born, “snuffles” -rhinorrhea, widespread desquamating rash, bone destruction, CVD, organ damage, deafness, saddle nose

Question 16

organism causing lyme

Answer 16

borrelia burgdorferi - Ixodes scapularis (blacklegged tick)

Question 17

rash caused with lyme

Answer 17

erythema migrans (bullseye)–> starts around lesion and spreads outward

8-10 days post bite, >5cm

can be associated with fatigue, malaise, headache, fever, chills, myalgias

Question 18

lyme associated arthritis

Answer 18

starts as migratory arthralgia - can progress to lyme arthritis

spreads from one joint to another

Question 19

lyme carditis

Answer 19

risk of arrhythmias (AV block) and myocarditis

adam-stokes syndrome (lose consciousness due to heart block)

Question 20

neurologic symptoms with lyme

Answer 20

cranial nerve disorders: facial nerve palsy, paresthesia, paresis

Polyneuropathy

Meningitis due to benign intracranial HTN

Encephalomyelitis (appears like MS - later stage), encephalopathy

Question 21

make a weird FACE when eating a LIME

Answer 21

F: facial nerve palsy
A: arthritis
C: carditis
E: erythema migrans

Question 22

i think a patient has lyme, how do I diagnose?

Answer 22

enzyme immunoassay (EIA) + immunofluroesence assay

or ELISA

if positive, confirm with IgG +/- IgM

Question 23

i do have lyme, treat me

Answer 23

localized: doxy is first line, amoxicillin, cefuroxime
disseminated: ceftriaxone