LEMONS OR LYMES?
Learning Objectives
• 1. Participants will be able to identify symptoms
of Lyme Disease
• 2. Participants will be able to determine if further
work-up is required
• 3. Participants will be able to recognize when it is
possible that Lyme Disease is not the cause of
the patient’s symptoms
History
• 1. known tick bite or rash
• 2. flu-like illness during the summer
• 3. onset of illness
• 4. other evaluations (cardiac, neuro, neurosurg, ortho,
rheumatology) & diagnoses
• 5.tests performed (i.e. TSH, CBC with diff, CMP, imaging studies,
EEG, EMG
• 6. treatments (effective and ineffective)
• 7. age (kiddos, elderly)
Info you all ask for on a regular
basis
• Medication allergies
• PMH
• PSH
• Current meds and supplements
Review of Systems
•
General: fatigue, fevers, sweats
•
Head, eyes, ears, nose and throat: blurring of vision, tinnitus, photophobia,
phonophobia
•
Neck: pain or stiffness
•
Lungs: shortness of breath, cough
•
Cardiac: palpitations, chest pain
•
Gastrointestinal: nausea, vomiting, diarrhea, constipation
•
Genito-urinary: urgency, frequency, testicular discomfort
•
Muscular-skeletal: myalgias and location; arthralgias and location
•
Neurological: paresthesias (location, type), h/a, dizziness (? ENT eval results)
•
Cognitive: Short-term memory loss, lack of concentration, word-finding difficulty
Physical Exam
• 1. General
• 2. HEENT
• 3. Neck
• 4. Lungs
• 5. Cardiac
• 6. Abdominal
• 7. M/S: strengths, ROM
• 8. Neuro: DTRs, CN
• 9. Mini-mental
Closing
• 1. Be honest.
• 2. Offer advice.
• 3. Remember that our patients have much to
teach us.