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A 32 year old previously healthy male returns from a vacation camping in New Mexico when he presents complaining of a sore on his left arm, with swollen lymph nodes under his left arm. He states he thinks he had a tick bite at that site 3 or 4 days ago. Examination reveals an ulcer with pronounced edges and a depressed center as well as tender axillary lymphadenopathy. Which of the following is the most appropriate differential diagnosis?
A . Lyme disease, Rocky Mountain spotted fever,
Ulceroglandular tularemia.
B . Rocky Mountain spotted fever, Bubonic
plague, Cutaneous anthrax.
C . Cutaneous anthrax, Ulceroglandular tularemia, Bubonic plague.
D . Ulceroglandular tularemia, Cutaneous anthrax, Lyme disease.
E . Bubonic plague, Ulceroglandular tularemia,
Rocky Mountain spotted fever.
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