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INTRODUCTION

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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

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PATIENT SUMMARY

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Chief Complaint

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"I have been feeling very dizzy and have had a severe headache since last night."

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History of Present Illness

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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.

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Past Medical History

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Syphilis × 3 years

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Depression × 5 years

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GERD × 1 year

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HIV × 1 month

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HTN × 2 years

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Recurrent yeast infections

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Family History

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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.

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Social History

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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.

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Tobacco/Alcohol/Substance Abuse

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Smokes 1 ppd × 15 years; (−) alcohol; (−) illicit drug use

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Allergies/Intolerances/Adverse Drug Events

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Penicillin (anaphylaxis)

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Medications (Current)

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Venlafaxine 150 mg PO q 24 h

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Yaz 1 tablet PO q 24 h

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Lisinopril 40 mg PO q 24 h

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Efavirenz 600 mg PO q 24 h at bedtime

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Emtricitabine/tenofovir PO q 24 h

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St. John's Wort 1 tablet PO daily

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Acetaminophen 500 mg PO q 4 h PRN headache

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Medications (Past)

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Doxycycline 100 mg PO q 12 h × 14 days for the treatment of syphilis

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Miconazole (Monistat-7)

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Tioconazole (Vagistat 1)

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Fluconazole 150 mg PO × two tablets

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Review of Systems

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Headache, not relieved with nonaspirin pain reliever;

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(−) 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; (+) ...

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