Bioterrorism and Emerging Infection Education
Case 1 - Tularemia

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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