b’xc2xa0Lyme Diseasexc2xa0 A 38-year-old male had a 3-week history of fatigue and lethargy with intermittent complaints of headache, fever, chills, myalgia, and arthralgia. According to the history, the patientxc2x92s’

b”nxc2xa0Lyme Diseasexc2xa0A 38-year-old male had a 3-week history of fatigue and lethargy with intermittent complaints of headache, fever, chills, myalgia, and arthralgia. According to the history, the patientxe2x80x99s symptoms began shortly after a camping vacation. He recalled a bug bite and rash on his thigh immediately after the trip. The following studies were ordered:xc2xa0Studies Results Lyme disease test, Elevated IgM antibody titers against Borrelia burgdorferi (normal: low)xc2xa0Erythrocyte sedimentation rate (ESR), 30 mm/hour (normal: xe2x89xa415 mm/hour) Aspartate aminotransferase (AST), 32 units/L (normal: 8-20 units/L)xc2xa0Hemoglobin (Hgb), 12 g/dL (normal: 14-18 g/dL)xc2xa0Hematocrit (Hct), 36% (normal: 42%-52%)xc2xa0Rheumatoid factor (RF), Negative (normal: negative)xc2xa0Antinuclear antibodies (ANA), Negative (normal: negative)xc2xa0Diagnostic Analysisxc2xa0Based on the patient’s history of camping in the woods and an insect bite and rash on the thigh, Lyme disease was suspected. Early in the course of this disease, testing for specific immunoglobulin (Ig) M antibodies against B. burgdorferi is the most helpful in diagnosing Lyme disease. An elevated ESR, increased AST levels, and mild anemia are frequently seen early in this disease. RF and ANA abnormalities are usually absent.xc2xa0Critical Thinking Questionsxc2xa01. What is the cardinal sign of Lyme disease? (always on the boards)xc2xa02. At what stages of Lyme disease are the IgG and IgM antibodies elevated?xc2xa03. Why was the ESR elevated?xc2xa04. What is the Therapeutic goal for Lyme Disease and what is the recommended treatment.Peripheral Vascular Diseasexc2xa0A 52-year-old man complained of pain and cramping in his right calf caused by walking two blocks. The pain was relieved with cessation of activity. The pain had been increasing in frequency and intensity. Physical examination findings were essentially normal except for decreased hair on the right leg. The patientxe2x80x99s popliteal, dorsalis pedis, and posterior tibial pulses were markedly decreased compared with those of his left leg.xc2xa0Studies Results Routine laboratory work Within normal limits (WNL)xc2xa0Doppler ultrasound systolic pressures Femoral: 130 mm Hg; popliteal: 90 mm Hg; posterior tibial: 88 mm Hg; dorsalis pedis: 88 mm Hg (normal: same as brachial systolic blood pressure)xc2xa0Arterial plethysmography Decreased amplitude of distal femoral, popliteal, dorsalis pedis, and posterior tibial pulse wavesxc2xa0Femoral arteriography of right leg Obstruction of the femoral artery at the midthigh levelxc2xa0Arterial duplex scan Apparent arterial obstruction in the superficial femoral arteryxc2xa0Diagnostic Analysisxc2xa0With the clinical picture of classic intermittent claudication, the noninvasive Doppler and plethysmographic arterial vascular study merely documented the presence and location of the arterial occlusion in the proximal femoral artery. Most vascular surgeons prefer arteriography to document the location of the vascular occlusion. The patient underwent a bypass from the proximal femoral artery to the popliteal artery. After surgery he was asymptomatic.xc2xa0Critical Thinking Questionsxc2xa01. What was the cause of this patient’s pain and cramping?xc2xa02. Why was there decreased hair on the patient’s right leg?xc2xa03. What would be the strategic physical assessments after surgery to determine the adequacy of the patient’s circulation?xc2xa04. What would be the treatment of intermittent Claudication for non-occlusion?xc2xa0 “