1. LEMONS OR LYMES?

2. 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

3. 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)

4. Info you all ask for on a regular basis Medication allergies PMH PSH Current meds and supplements

5. 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

6. 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

7. Closing 1. Be honest. 2. Offer advice. 3. Remember that our patients have much to teach us.