Lyme Disease with Bell Palsy and meningismus

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Women went hiking in the woods. Saw a tick bite her. Saw a target rash on her, which has faded weeks before this vignette...

Next best step?

I figure Lyme serology titers



But Kaplan qbank insists that is not the next best step. Rather lumbar puncture is.

While I see the logic of this, would that really be the next best step?

is that the whole case? I would do an LP if she had signs or symptoms of meningeal irritation. but more importantly, I think starting treatment would be better than waiting for the results of an LP. In either case, according to MTB a head CT sh. be done first before an LP.

Again, there has to be more to the case.

That was essentially the gist of the case. CT scan was not a choice.

Kaplan Qbank has a habit of omitting details here and there and really leaving you out on an island to try to answer their hard questions

I suppose this is just test taking... choose the next best AVAILABLE step

Lol, well then yes doing an LP would be a good choice imho b/c ruling out meningitis is more important than confirming lyme.

Originally Posted by Metaform

Lol, well then yes doing an LP would be a good choice imho b/c ruling out meningitis is more important than confirming lyme.

Yes would you do a quick LP and then start antibiotics? Start the antibiotics after LP but before LP results return..??

Originally Posted by NRAI2001

Yes would you do a quick LP and then start antibiotics? Start the antibiotics after LP but before LP results return..??

Do LP -> start empiric abx -> wait for results to return and change abx as necessary

Of course if there were neurological deficits noted, then you have to give the empiric Abx during the CT scan (even if it affects the LP yield)

Originally Posted by SlaveOfTCMC

Of course if there were neurological deficits noted, then you have to give the empiric Abx during the CT scan (even if it affects the LP yield)

In real life yes; not sure how that would present (or if they would even present that at all) on a test question.

I've seen one in the Kaplan qbank in which they presented a panel of LP results (which were consistent with partially resolved bacterial meningitis) with a vignette of an individual who had classic signs..

the answer choice was "patient had Abx before LP"

it was very vague and unless one knows of how this algorithm works in real life, that answer choice could have seemed extremely deceptive.