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. Educational Objective: References: ]]
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::