WBR0004
Author | PageAuthor::Anonymous (Edited by Will Gibson) |
---|---|
Exam Type | ExamType::USMLE Step 2 CK |
Main Category | MainCategory::Internal medicine |
Sub Category | SubCategory::Infectious Disease, SubCategory::Infectious Disease |
Prompt | [[Prompt::A 34-year-old man presents to the health center concerned that he has contracted a venereal disease. He nervously shows you an ulcerated lesion on the shaft of his penis and states that it has been present for over 1 week. On physical exam, the man is afebrile and except for mild lymphadenopathy in the neck, has a nontender ulcer on his penis measuring 1.5 x 1 x 0.5 cm. Laboratory testing demonstrates that he is VDRL positive. What is the next step in diagnosis?]] |
Answer A | AnswerA::Repeat VDRL in 1 week. |
Answer A Explanation | AnswerAExp:: |
Answer B | AnswerB::Obtain RPR for confirmation. |
Answer B Explanation | AnswerBExp:: |
Answer C | AnswerC::Obtain DS-DNA serology. |
Answer C Explanation | AnswerCExp:: |
Answer D | AnswerD::Obtain a fluorescent treponemal antibody absorption (FTA-ABS). |
Answer D Explanation | AnswerDExp:: |
Answer E | AnswerE::Proceed with treatment of the suspected disease. |
Answer E Explanation | AnswerEExp:: |
Right Answer | RightAnswer::D |
Explanation | [[Explanation::This patient's clinical presentation and positive VDRL are consistent with primary syphilis. However, correct diagnosis should be confirmed with treponemal testing (either FTA-ABS or FTA-TP) before treatment since VDRL and RPR may be turned falsely positive by some autoimmune diseases.
WJG NOTES: This question strikes me as a bit off. Why wouldn't you just treat the patient with penicillin? It's not as though you are giving a toxic chemotherapy - and there are no other signs of autoimmune disease in this patient such as synovitis or joint problems. |
Approved | Approved::No |
Keyword | WBRKeyword::Syphilis, WBRKeyword::Venereal, WBRKeyword::Sexual, WBRKeyword::Sexually transmitted infections, WBRKeyword::STI, WBRKeyword::STD |
Linked Question | Linked:: |
Order in Linked Questions | LinkedOrder:: |