Rotations 2.0 Episode 60 Mononucleosis

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Intro Music: KI Instrumental (Rock Celtic) by Lyrium-2025

Outro Music: Cloud Atlas by Alex Grohl

Courtesy of Pixabay under Creative Commons non-commercial use.

Produced by: Todd Fredricks DO MSS 

Edited by: Todd Fredricks DO MSS

Answers for Episode 58 Abcesses

Question 1 – Diagnosis of Early Lyme Disease

A 42‑year‑old woman from Pennsylvania presents with 5 days of fever, fatigue, headaches, and diffuse myalgias. She denies noticing a tick bite. Physical examination reveals no rash. Initial two‑tier Lyme serology (ELISA + Western blot) is negative. Which of the following is the most accurate interpretation of this test result?

C. Serologic testing is often insensitive in early Lyme disease, and a negative early test does not exclude infection

Question 2 – Persistent Symptoms After Treatment

A 33‑year‑old man was treated for early Lyme disease 9 months ago with a standard course of doxycycline. He now reports debilitating fatigue, impaired concentration, unrefreshing sleep, and intermittent musculoskeletal pain that have persisted for 6 months and interfere with daily life. Which of the following features best supports the diagnosis of Post‑Treatment Lyme Disease Syndrome (PTLD)?

B. Prolonged symptoms affecting functional ability ≥6 months after standard treatment

Question 3 – Antibiotic‑Refractory Lyme Arthritis

A 55‑year‑old woman presents with persistent right‑knee swelling 3 months after completing two courses of oral doxycycline for Lyme arthritis. Synovial fluid analysis shows an inflammatory profile but no bacterial growth. Which mechanism best explains her persistent joint inflammation?

C. Persistence of Borrelia peptidoglycan antigenic debris that promotes ongoing inflammation

Paper for Next Week:

El Feghaly, R. E., Nedved, A., Katz, S. E., & Frost, H. M. (2023). New insights into the treatment of acute otitis media. Expert Review of Anti-infective Therapy, 21(5), 523–534. 

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