Eagle_303
Forum Guru
Topics: 77
Posts: 655
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A 25-year-old male student presents with the chief complaint of rash. There
is no headache, fever, or myalgia. A slightly pruritic maculopapular rash is
noted over the abdomen, trunk, palms of the hands, and soles of the feet.
Inguinal, occipital, and cervical lymphadenopathy is also noted. Hypertrophic,
flat, wartlike lesions are noted around the anal area. Laboratory
studies show the following:
Hct: 40%
Hgb: 14 g/dL
WBC: 13,000/μL
Diff:
Segmented neutrophils: 50%
Lymphocytes: 50%
3. The most useful laboratory test in this patient is
a. Weil-Felix titer
b. Venereal Disease Research Laboratory (VDRL) test
c. Chlamydia titer
d. Blood cultures
4. The treatment of choice for this patient is
a. Penicillin
b. Ceftriaxone
c. Tetracycline
d. Interferon α
e. Erythromycin
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| docdoc9
Forum Guru
Topics: 63
Posts: 521
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VDRL
Penicillin
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| drms
Forum Guru
Topics: 14
Posts: 947
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B
A
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| Eagle_303
Forum Guru
Topics: 77
Posts: 655
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3–4. The answers are 3-b, 4-a. (Braunwald, 15/e, pp 1046–1047.) The diffuse
rash involving palms and soles would in itself suggest the possibility of
secondary syphilis. The hypertrophic, wartlike lesions around the anal area,
called condylomata lata, are specific for secondary syphilis. The VDRL slide
test will be positive in all patients with secondary syphilis. The Weil-Felix
titer has been used as a screening test for rickettsial infection. In this patient,
who has condylomata and no systemic symptoms, Rocky Mountain spotted
fever would be unlikely. No chlamydial infection would present in this way.
Blood cultures might be drawn to rule out bacterial infection such as chronic
meningococcemia; however, the clinical picture is not consistent with a systemic
bacterial infection. Penicillin is the drug of choice for secondary
syphilis. Ceftriaxone and tetracycline are usually considered to be alternative
therapies. Interferon α has been used in the treatment of condyloma acuminata,
a lesion that can be mistaken for syphilitic condyloma.
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| dr.wad
Forum Senior
Topics: 3
Posts: 350
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yes B and A
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| paheli
It'sAllAboutGoodKarma
Topics: 197
Posts: 2,720
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Yep, B, A.
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