A12-year-old girl was in her normal state of good health when she developed a fever of several days duration. she had no localizing symptoms, except for the development of a large rash on her back (see below). her history was notable in that she lived in connecticut near the new york state border and had recently been walking through tall grass where her sister was taking horseback riding lessons.1. with what organism was she infected? what disease did she have? 2. what in her history is suggestive of this disease? how is this disease transmitted? 3. how, in the absence of a characteristic rash, is the diagnosis of this disease established? 4. she was appropriately treated with antibiotics and did well. what complications can occur in patients with this disease, particularly those in whom there is no treatment or inadequate therapy? 5. what efforts can be taken to prevent this illness

A46-year-old man with a history of hypertension and hypercholesterolemia visits the physician for a routine followup. the patient's job involves a lot of travelling, and he admits to occasionally forgetting to take his medications with him when he travels. he complains of several episodes of chest pain in the past few months. the pain is sharp in nature, mainly over his lower chest and epigastrium, and tends to come on when walking. he believes these episodes are due to indigestion and has been taking antacids. there is a family history of heart disease, and his father died of a heart attack at age 48. on physical examination, his blood pressure is 150/80 mmhg and heart rate is 86/min. his lungs are clear to auscultation. cardiac auscultation reveals normal rate and rhythm, without rubs, gallops, or murmurs. there is no pedal oedema. he is sent for an exercise stress test. five minutes into the test, he develops st depression of 3mm in leads v1-v5. the st segment depression is greater than 0.12 seconds in duration and the stress test is stopped. which of the following is the most appropriate next step in management? - coronary angiography- holter monitor- no further tests are required- repeat stress test with thallium- upper gastrointestinal endoscopy