WBR0004
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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. |
| Approved | No |
| Keyword | Syphilis, Venereal, Sexual, Sexually transmitted infections, STI, STD |
| Linked Question | |
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