WBR0004

Author	PageAuthor::
Exam Type	ExamType::USMLE Step 1
Main Category	MainCategory::Genitourinary
Sub Category	SubCategory::Microbiology
Prompt	[[Prompt::A 34-year-old man comes to the health center with fears 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 shows him to be 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 likely has syphilis by clinical presentation and positive VDRL testing; however, correct diagnosis should be made with confirmation with treponemal testing (either FTA-ABS or FTA-TP) before treatment since VDRL and RPR may be turned falsely positive by some autoimmune diseases. Educational Objective: References: ]]
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