Ixodes scapularis nymph

Discussion in 'USMLE STEP 2 CS' started by Dev., Apr 8, 2008.

  1. Dev.

    Dev. Guest

    A 19-year-old woman from Indianapolis comes to the emergency department of a New Jersey hospital with a tick on her right arm. She first noted the tick 9 hours ago. The patient was on a 2-week college industrial-ecologic field trip, during which time she toured a factory or a nature habitat each day and returned to the hotel each evening. She showered daily. She is healthy and takes no medications.

    The emergency department physician identified the tick as an Ixodes scapularis nymph that was not engorged. After removing the tick, there was no evidence of redness or inflammation at the site of the bite, although the tick had definitely been attached. No residual tick parts were left in the skin. Which of the following is the most appropriate management at this time?

    A. Observation
    B. Amoxicillin, 500 mg orally three times daily for 10 days
    C. Azithromycin, 1 g orally daily for 10 days
    D. Cefuroxime-axetil, 500mg orally twice daily for 10 days
    E. Doxycycline, 200 mg orally once daily

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