Objectives:

• Identify and diagnose Rocky Mountain spotted fever
• Initiate treatment of Rocky Mountain spotted fever
• Recognize other tick-borne illnesses

1		A 45-year-old physician who has recently returned from an early summer fishing vacation (Physician? Vacation? Sounds like an oxymoron.) in rural North Carolina presents for a febrile illness. He reports a 5-day history of fever, malaise, headache, and vomiting. Today he has developed a maculopapular eruption that began on his extremities and has spread to his body. It involves his palms and soles and is nonpruritic. The most likely diagnosis is:
			A)	Chicken pox.
			B)	Syphilis.
			C)	Parvovirus.
			D)	Rocky Mountain spotted fever.
			E)	Human monocytic ehrlichiosis.
2		What is the appropriate treatment for this patient?
			A)	Obtain serologic studies and treat symptoms with nonsteroidal antiinflammatory agents.
			B)	Penicillin VK 500 mg PO TID for 14 days.
			C)	Levofloxacin 500 mg IV q 24 hours for 10 days.
			D)	Admit to the hospital and begin IV ceftriaxone 1 gram q 24hours until fever has resolved.
			E)	Doxycycline 100 mg PO BID for 14 days.