A 20-year-old construction worker called into the company clinic with a complaint of low-grade fever, malaise, and headache. He was told to take two aspirins every four hours and get back to work. He came in 4 days later. His headache had never completely gone away , and he now was having trouble with his vision, he said some things he look at looked like there were two of them. The first thing you ask him is if he has a stiff neck.
Question 1 - Single Best Answer
What disease are you considering when you ask him about his neck?
A) acute job stress and on-the job neck injury
B) encephalitis
C) meningitis
D) septicemia
E) Lyme disease
Question 2 - Single Best Answer
What are some common causes of meningitis?
A) Streptococcus pneumonia, Haemophilus influenzae, and Neisseria gonorrhoea
B) Streptococcus pneumonia, Haemophilus influenzae, and Neisseria meningitidis
C) Streptococcus pyogenes, Listeria monocytogenes, and Staphylococcus aureus
D) Treponema pallidum, Haemophilus ducreyi, and Neisseria gonorrhoea
Question 3 - Single Best Answer
What would be a likely cause of meningitis in this young man's age group (young adult)?
A) Listeria monocytogenes
B) Streptococcus pneumoniae
C) Haemophilus influenzae
D) Neisseria meningitidis
He replies that is head bothers him more than his neck. You begin your examination and notice that his trunk is covered with some reddish, maculopapular lesions. He had a temperature of 38.8.
Question 4 - Single Best Answer
What does maculo-papular mean?
A) a rash that itches
B) purplish discoloration
C) blisters
D) a rash with elements of macular and papular
E) scaly
Question 5 - Single Best Answer
What bacteria can cause a maculopapular rash?
A) Streptococcus pyogenes, Streptococcus pneumonia, Staphylococcus aureus and Rickettsia rickettsii
B) Treponema pallidum, Salmonella typhi, Borrelia recurrentis, Haemophilus influenzae
C) Borrelia burgdorferi, Treponema pallidum, Rickettsia rickettsii
D) Gardnerella vaginalis, Staphylococcus saprophiticus, Haemophilis influenzae, Clostridium tetani
Question 6 - Single Best Answer
What are some non-bacterial causes of a rash?
A) food allergies
B) measles or rubella virus
C) spirochetes
D) more than one of the above
E) all of the above
Question 7 - Single Best Answer
What problem caused by Staphylococcus aureus presents with a rash?
A) boil
B) pneumonia
C) arthritis
D) toxic shock syndrome
E) rheumatic fever
Question 8 - Single Best Answer
What bacteria can cause a rash on the palms and soles?
A) Staphylococcus aureus and Streptococcus pyogenes
B) B. burgdorferi
C) Staphylococcus saprophyticus
D) T. pallidum and R. rickettsii
E) N. meningitidis and N. gonorrhoea
During your examination you also notice some grayish-white lesions in his groin. You put on gloves and palpate them. He says they are painless.
Question 9 - Single Best Answer
What are these called?
A) rose spots
B) morbilliform spots
C) white spots
D) condyloma lata
E) erythema chronicum migrans
Question 10 - Single Best Answer
What are these lesions often a sign of?
A) measles
B) Neisseria meningitidis
C) gonorrhea
D) syphillis
Question 11 - Single Best Answer
Why did you put on gloves before palpating these?
A) they may contain the AIDS virus
B) they may contain measles virus
C) they may contain spirochetes
Question 12 - Single Best Answer
What questions would be most important to ask the young man now?
A) outdoor activities
B) sexual history
C) contact with animals
D) problems urinating
You find that the young man is not the outdoor type, but prefers indoor exercise. Much of this involves the opposite sex. His only contact with animals is his Jack Russell terrier, Randy. He was asked about any history of sexually transmitted diseases and he revealed that he had gonorrhea three times in the past three years, had occasional outbreaks of Herpes, but was HIV negative. He also revealed that one month previously, he had a painless ulcer on his penis. He did not worry about this, however, as it had gone away after about six days, and, because it was painless, hadn't hindered his favorite sport!
Question 13 - Single Best Answer
How long after exposure to someone with syphilis, does one develop the primary chancre?
A) 3days
B) 10 days
C) 3 weeks
D) 3 months
Question 14 - Single Best Answer
How is it that the young man could have repeated cases of gonorrhea?
A) N. gonorrhoea does not stimulate the formation of antibody.
B) Neisseria gonorrhoea is an obligate intracellular parasite but it fails to stimulate a CMI response.
C) N. gonorrhoea can undergo antigenic variation so that antibody to one strain is ineffective against subsequently infecting strains.
D) N. gonorrhoea's principle virulence factor is a capsule.
E) His N. gonorrhoea could produce beta-lactamase so that he couldn't be cured by penicillin.
Question 15 - Single Best Answer
What could have been the cause of his penile ulcer?
A) Haemophilus ducreyi (chancroid)
B) Treponema pallidum (syphilis)
C) Herpes virus
D) a recurrence of his gonorrhea
E) chlamydia infection
Question 16 - Single Best Answer
Could his syphilitic chancre possibly have anything to do with his present rash and headache?
A) yes
B) no
Question 17 - Single Best Answer
What diagnostic test would you perform at this point?
A) Gram stain of the lesions (the rash)
B) VDRL
C) HIV antibody test
D) blood culture
Question 18 - Single Best Answer
What does a VDRL measure?
A) anti-syphilis antibody
B) treponemal antigen
C) anti-cardiolipin antibody
D) it is a panel of tests for syphilis, gonorrhea, and herpes
You find that he has a high VDRL test. His measures 1:256. You also order an FTA-abs.
Question 19 - Single Best Answer
What is an FTA-abs test?
A) indirect immunoflourescent antibody test
B) specific treponemal test
C) a test that uses patient serum adsorbed with non-pathogenic treponemes
D) all of the above
Question 20 - Single Best Answer
At this point, what would your presumptive diagnosis of the young man's disease be?
A) primary syphilis
B) secondary syphilis
C) tertiary syphilis
D) AIDS
Question 21 - Single Best Answer
Was it unusual for the man’s syphilitic chancre to disappear without treatment?
A) Yes
B) No
Question 22 - Single Best Answer
How long after primary syphilis does secondary syphilis usually occur?
A) 1-2 weeks
B) 1 to 3 months
C) 2-6 months
D) 1-2 years
Question 23 - Single Best Answer
What are some other symptoms the young man could have had with secondary syphilis?
A) alopecia
B) lymphadenitis
C) enlargement of the epitrochlear lymph node
D) basilar meningitis
E) hepatitis
F) all of the above
Question 24 - Single Best Answer
A common sign of secondary syphilis is a rash on the palms and soles. He did not have this why?
A) it is a very early sign and goes away before the rash on the trunk appears
B) the rash spreads from the trunk to the extremities, so this may appear later
C) because he was a construction worker the skin on his palms and soles was very tough and the spirochetes couldn’t enter there.
The FTA-abs test conclusively indicated that the young man had syphilis.
Question 25 - Single Best Answer
Had he not been treated, what is the most worrisome occurance?
A) His current symptoms would have lasted for several more weeks with the chance that he could spread the disease but then he would have had no further problems
B) He would not be sick but might remain infectious for life
C) He would become antibody negative so no one could ever tell that he had been infected
D) He could be well for 10-20 years and then develop late (tertiary) syphilis
Question 26 - Single Best Answer
What are the signs of tertiary syphilis?
A) neurological abnormalities
B) cardiovascular problem
C) demyelination of the dorsal root ganglia
D) bone lesions
E) non-healing ulcers
F) all of the above
Question 27 - Single Best Answer
How can a syphilitic woman affect her unborn child?
A) the baby may be stillborn
B) the baby may have “snuffles”
C) the baby may be born with a rash
D) the baby may suffer mental retardation and failure to thrive
E) all of the above
Question 28 - Single Best Answer
What is the pathogenesis of congenital syphilis; i.e., how do the bacteria encounter the fetus?
A) they pass through the placenta
B) they affect the baby as it passes through the birth canal
Question 29 - Single Best Answer
What is the relationship, if any, of syphilis and HIV/AIDS?
A) AIDS increases the transmission of syphilis
B) syphilis increases the transmission of HIV
C) individuals with syphilis progress to AIDS more quickly
Question 30 - Single Best Answer
Which of the following is a non-venereal treponematosis?
A) Lyme disease
B) malaria
C) bejel
D) Cat Scratch fever
E) snuffles
Syphilis is interesting from a pathogenic, epidemiological and historical standpoint. Syphilis is transmitted by sexual contact. It is thought that the organisms enter the skin through tiny breaks, aided by their rapid motility. They multiply locally and an indurated, nontender ulcer occurs at the site of innoculation, usually after 2-4 weeks. This is the primary syphilitic chancre, also known as hard chancre, and is the first stage of the disease. The lesion is literally teaming with spirochetes and demonstrating live organisms in the chancre fluid, by means of dark-field microscopy, is pathognomonic for syphilis. This primary lesion will heal by itself after 10 days-2 weeks. 1-3 months later, secondary lesions may appear as a maculopapular rash or as moist papules on the skin and mucous membranes. The rash is distinguishable by the fact that it occurs on the palms and soles. These lesions are also loaded with spirochetes and, like the primary lesion, will heal by themselves. These two stages together constitute early syphilis. Approximately one-third of cases of early syphilis will result in a spontaneous cure, and previously antibody-positive individuals will become antibody-negative. Another third of cases will become latent syphilis, with positive serologic tests indicating infection, but will never reactivate. The remaining third will progress to late or tertiary syphilis. This stage is characterized by multiorgan involvement with few organisms found in the lesions. Bone, connective tissue, central nervous system, and cardiovasular tissue may all be involved. Because so few organisms are found at this stage it is thought that the damage may result from immune mechanisms. T. pallidum is one of the few bacteria that can be transmitted from a pregnant woman to her fetus transplacentally. The transmitted disease is called congenital syphilis, and can produce still births or babies with multiple fetal abnormalities.