A 25-year-old man comes to the physician's office due to left knee swelling and pain. He has 3-week history of fatigue and a rash. The patient reports going camping last month but denies having been bitten by a tick. His past medical history is significant for penicillin allergy . His pulse is 54/min and blood pressure is 110/72. Physical examination reveals multiple circular red rings with central clearings on the right arm and chest. There is a normal range of motion in all joints and 5/5 strength bilaterally in the upper and lower extremities. Which of the following might have prevented this patient's knee condition?

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Eductional Objective: Early Lyme disease causes flu-like symptoms and erythema chronicum migrans. The second stage of Lyme disease may involve atrioventricular block and facial palsy. Late Lyme disease can cause chronic asymmetric large joint arthritis and encephalopathy. Lyme disease is easily treated with doxycycline or penicillin-type antibiotics (eg, ceftriaxone).

A 25-Year-Old Man Comes to the Physician's Office Due to Left