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Author Anonymous (Edited by Will Gibson)
Exam Type USMLE Step 2 CK
Main Category Internal medicine
Sub Category Infectious Disease, Infectious Disease
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 Repeat VDRL in 1 week.
Answer A Explanation
Answer B Obtain RPR for confirmation.
Answer B Explanation
Answer C Obtain DS-DNA serology.
Answer C Explanation
Answer D Obtain a fluorescent treponemal antibody absorption (FTA-ABS).
Answer D Explanation
Answer E Proceed with treatment of the suspected disease.
Answer E Explanation
Right Answer D
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.
Educational Objective:

Approved No
Keyword Syphilis, Venereal, Sexual, Sexually transmitted infections, STI, STD
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