drk1980
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this was a step 1 NBME q as i rmber...
A 24-year-old man presents with fever, rash, a mild headache, and a sore throat. He denies HIV risk factors, although he is sexually active. On examination, his temperature is 100.8°F and his pulse is 90/min. There is a diffuse, erythematous, maculopapular rash over most of his body.
Generalized adenopathy is appreciated, and photophobia is noted when funduscopic examination is attempted. If this man is not treated, which of the following changes in his serologic status will most likely occur?
A. The FTA-ABS titer would fall
B. The FTA-ABS titer would rise
C. The VDRL titer would fall
D. The VDRL titer would rise
E. Both FTA-ABS and VDRL would fall
F. Both FTA-ABS and VDRL would rise
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| MAZI
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D
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| mazinger
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mmm its a secondary syphilis I think both serologic tests should rise.. vdrl is less specific for syphilis, but ftabs is very specific. vdrl can be measured is csf and decreases after treatment, ftabs remains positive for life..
I am not sure about the fotofobia...
Mazi do you think it could be something else besides syphilis?
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| MAZI
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I THINK THAT
PHOTOPHOBIA IS THE SIGN OF ANTERIOR UVEITIS DUE TO SYPHILIS
FTA ABS would be positive or negative, and has no titer but the titer of VDRL is an important in diagnosis and follow up treatment, after treatment the titer of vdrl decrease in about 6 months ( im not sure about this time correct me if i wrong.)
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| frank100
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assuming thi guy has secondary siphilis already, his FTA-ABS will always be positive (eventhough he gets treated), and is reported as: positive or negative only (won´t go up or down). so options (a), (b),(d), and (f) are not posible options. since VDRL leverls can go up an secondary siphilis, VDRL tend to go down in latest stages of the diseace.
so my answer is (c): the vdrl title would fall.
pd: if i´m wrong please leave me some flesh...
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| MAZI
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good question
i got it , you r right frank100
the highest titer are seen in secondary syphylis because you have a larg amount of treponema and then larg amount of IgG antibody against cardiolipin (exist in cell wall of treponema ), befor and after that you have a decreased level because you have a decreased level of organism in the blood and then decrease production of antibody against that
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| mazinger
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Dear Mazi:
ok, ok, I got the point of the uveitis (sad to say because I recently went through ophtho and forgot this precise fact that uveitis in fact can be caused by many things including syph  ).
I dont know, but I never have thought of ftabs just as a positive or negative test and no titers (just like eliza for HIV, you dont measure titers) what you state, sounds pretty logic to me...
thanks
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