A 34-Year-Old Man Comes to the Emergency Department Due to Skin

question 71

Multiple Choice

A 34-year-old man comes to the emergency department due to skin rash that he noticed this morning on his arms and legs.  He has also had fever and headache for 3 days.  The patient had a root canal 2 weeks ago with mild post-procedure pain and gum swelling.  Medical history is otherwise noncontributory.  He is an avid biker who enjoys spending time outdoors.  The patient does not use alcohol or tobacco.  He has a male partner with whom he has been in a stable relationship for the last 2 years.
Temperature is 39.7 C (103.5 F) , blood pressure is 122/70 mm Hg, and pulse is 114/min and regular.  No lymph node enlargement is present.  There is no sinus tenderness to palpation.  The lungs are clear to auscultation.  There are no heart murmurs.  The abdomen is soft and nontender, and the tip of the spleen is not palpated.  Maculopapular rash with petechiae is present on the arms and legs.  There are no meningeal signs.
Laboratory results are as follows:
Two blood smears are negative for potential blood-borne pathogens.
Which of the following is the most appropriate next step in management of this patient?

• A)Doxycycline
• B)Lumbar puncture
• C)Monospot test
• D)Syphilis serology
• E)Transesophageal echocardiogram

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