When to begin studying?  Where to start?

If you’re unsure of  where to begin or how to get started follow along as we cover the NCCPA blueprint.

Spirochetal Disease

by Phoebe on March 31, 2015


Erythema migrans

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Lyme Disease

Things you should know

  • Borrelia burgdorferi
  • Transmitted by a deer tick bite – it takes between 36 and 48 hours to transfer the bacteria.
  • The deer tick is found in high grass or wooded areas

Signs and Symptoms

  • Early localized stage (about 1 week after the bite)
    • Erythema Migrans – Bull’s eye rash (about 1 week after bite)
    • Fever
    • Malaise
    • Flu like symptoms
  • Early disseminated stage (weeks)
    • Muscle and joint pain
    • Facial or Bell’s palsy
    • Severe headaches and neck stiffness – due to inflammation of the spinal cord (meningitis)
    • Pain and swelling in the large joints (such as knees)
    • Pericarditis, arrhythmias
    • Shooting pains that may interfere with sleep
  • Late disseminated stage (months)
    • Arthritis most commonly in the large joints
    • Shooting pains
    • Polyneuropathy
      • numbness and tingling in the hands or feet
    • Mood changes and memory loss
    • Fatigue
    • Untreated disease can have significant cognitive and psychological manifestations

Physical exam findings

  • Erythema Migrans – A small, red bump may appear at the site of the tick bite, which later the redness expands forming a rash in a bull’s-eye pattern, with a red outer ring surrounding a clear area.


  • Clinical exam and history
  • A history possible exposure to a tick.  Most patients will not have any memory of a tick bite.
  • Blood tests (there are many cross reactive disease processes)
    • Enzyme-linked immunosorbent assay (ELISA) test.
      • Detects antibodies to B. burgdorferi.
      • False negatives in the early stage of Lyme disease
    • Western blot test.
      • Done following a positive ELISA test
      • detects antibodies to several proteins of B. burgdorferi.
    • Polymerase chain reaction (PCR)
      • This has been most helpful in joint fluid


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We cover over 50 review questions this week.
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Listen to over 50 review questions from the audio version!

This week we hit episode 100.  Thank you so much for being a part of this community.  It has really been amazing.  This week I’m changing the format a little. I’m releasing over 50 review questions from the audio version of the Final Step.


These are randomized sample of questions from all different topics.  I’ve gotten some great feedback on the questions at the end of each show, so I thought I would make this show all questions.  Enjoy!


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The rest of bacterial infections including cholera, diphtheria, tetanus and more ….

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