Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Interactive:
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Quiz
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Exams
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map

Review of Clinical Signs Review Questions

Manifestations of Syphilis

Bernard M. Karnath, MD

Choose the single best answer to each question.

1. A 25-year-old man presents with a 2-day history of a painless ulcer located on his glans penis. The ulcer is 0.5 cm in diameter. The patient admits to recent unprotected intercourse 3 weeks ago with an unknown partner. Dark field microscopy confirms the diagnosis of syphilis. The patient is allergic to penicillin. What is the best treatment option for this patient?

  1. One dose of azithromycin 1 g orally
  2. One dose of ceftriaxone 250 mg intramuscularly
  3. Doxycycline 100 mg orally twice daily for 14 days
  4. Levofloxacin 250 mg orally once daily for 7 days
Click here to compare your answer.


2. A 30-year-old man presents with a 3-day history of a painful ulcer located on the dorsum of his penis. The ulcer is 1 cm in diameter. The patient also has tender bilateral inguinal lymphadenopathy. The patient admits to recent unprotected intercourse 3 weeks ago with a prostitute. Dark field microscopy and rapid plasma reagent testing are negative. What is this patient’s most likely diagnosis?

  1. Chancroid
  2. Granuloma inguinale
  3. Lymphogranuloma venereum
  4. Gonorrhea
Click here to compare your answer.


Questions 3 and 5 refer to the following case:

A 30-year-old woman presents with a 1-week history of a generalized rash, fever, malaise, myalgias, and generalized lymphadenopathy. Her past medical history is significant for HIV diagnosed 5 years ago. Her most recent CD4+ count from 4 months ago is 350 cells/mm3. The rash involves the palms of the hands and the soles of the feet. Rapid plasma reagent testing is reactive at 1:64 dilutions. The patient has no known drug allergies.

3. What is the next step in the management of this patient?

  1. Begin treatment with doxycycline 100 mg orally twice daily for 14 days
  2. Begin treatment with levofloxacin 250 mg orally once daily for 7 days
  3. Lumbar puncture
  4. Dark field microscopy of the skin lesions
Click here to compare your answer.


4. The fluorescent treponemal antibody absorption (FTA-ABS) is positive. Lumbar puncture is performed and the VDRL-CSF is positive. What is the next step in the management of this patient?

  1. Initiate intravenous (IV) levofloxacin 500 mg daily for 14 days
  2. Initiate IV ceftriaxone 1 g every 12 hours for 10 days
  3. Initiate doxycycline 100 mg orally twice daily for 14 days
  4. Initiate IV penicillin G 2 to 4 million units every 4 hours for 14 days
Click here to compare your answer.


5. Approximately 2 hours after beginning treatment, the patient complains of chills and rigors. What do you recommend?

  1. Stop treatment
  2. Continue present treatment
  3. Consult an allergist for desensitization
  4. Draw 2 sets of blood cultures
Click here to compare your answer.

Click here to read more about Manifestations of Syphilis (Requires Adobe Acrobat Reader)


Review of Clinical Signs main page



Check our archives to test your knowledge in other clinical signs:

Review of Clinical Signs Archives


If you do not already have Acrobat Reader, simply click on the icon below, scroll down to the "Get the Free Acrobat Reader" heading and follow the instructions to install the program. Acrobat enables you to convert any document into an Adobe Portable Document Format (PDF) file for easy viewing.

Download Adobe Acrobat Reader

 

Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 2/05/09 • nvf