CASE LEARNING OBJECTIVES
Analyze the behavioral considerations and assess the importance of contraception with regard to the contributing factors
Apply the "expedited partner treatment" method when recommending treatment
Identify the patient populations that are epidemiologically affected
Identify the clinical signs and symptoms associated with tertiary syphilis
Select an appropriate therapy for the management of syphilitic meningitis
Develop an appropriate treatment and monitoring plan for the management of syphilitic meningitis
"I have been feeling very dizzy and have had a severe headache since last night."
History of Present Illness
A 35-year-old Hispanic female presents to her physician with complaints of a severe headache accompanied by vomiting and dizziness that has been present for 2 days.
Recurrent yeast infections
Father had colon cancer and died at the age of 55. Mother is alive at age 65, with a history of alcoholism and depression. She has two sisters who are alive and healthy.
The patient came to the United States from Mexico at the age of 13. She is fluent in both English and Spanish. Currently, she is married and lives with her husband of 5 years; she has one child of age 3. She works at a retail clothing store.
Smokes 1 ppd × 15 years; (−) alcohol; (−) illicit drug use
Allergies/Intolerances/Adverse Drug Events
Venlafaxine 150 mg PO q 24 h
Lisinopril 40 mg PO q 24 h
Efavirenz 600 mg PO q 24 h at bedtime
Emtricitabine/tenofovir PO q 24 h
St. John's Wort 1 tablet PO daily
Acetaminophen 500 mg PO q 4 h PRN headache
Doxycycline 100 mg PO q 12 h × 14 days for the treatment of syphilis
Fluconazole 150 mg PO × two tablets
Headache, not relieved with nonaspirin pain reliever;
(−) tinnitus; (+) vertigo; (+) infection; (+) Kernig's sign;(+) Brudzinski's sign; (+) cervical rigidity; (+) photophobia; (−) history of seizures, syncope, or loss of consciousness; A&O × 3; (−) rash; (−) petechiae; (+) ...