177 - Syphilis

Question 1

Treponema pallidum is transmitted mainly through __ contact, but also through __, __, or __.

Answer 1

sexual
intrauterine
blood transfusion
transplanted organ

Question 2

After incubation period of __ days, primary disease with a __ appear on site of infection.

Answer 2

21

chancre

Question 3

Chancre is usually __ and has a cartilage like texture

Answer 3

unpainful

Question 4

Local __, mostly __ and bilateral, appear __ after the chancre.

Answer 4

lymphadenopathy
inguinal
a week

Question 5

The chancre will disappear after - weeks, but the lymphadenopathy stays for __.

Answer 5

4-6

months

Question 6

Secondary syphilis appear - weeks after primary and includes a combination of __/__/__/__ lesions.

Answer 6

6-12

macular/papular/papulosquamous/pustular

Question 7

The secondary disease lesions involve mostly the __ and __. They do not cause __ and later may involve the __.

Answer 7

back
limbs
pruritus
palms

Question 8

Mucous patches are __ erosions with red borders, unpainful, mostly on oral/genital mucosa

Answer 8

silver

Question 9

Lues maligna are __ lesions, and are more common in __ patients.

Answer 9

necrotic

HIV

Question 10

On skin folds the papules can cause __- which are __ and very __ lesions with pink-grey appearance.

Answer 10

condylomata lata
moist
infective

Question 11

Which systemic symptoms may appear in secondary syphilis? 5

Answer 11

pharyngitis
fever
weigh loss
malaise
headache

Question 12

Acute __ is a possible CNS symptom in secondary syphilis

Answer 12

meningitis

Question 13

Secondary syphilis may cause ocular symptoms: 3. If untreated they may cause permanent __

Answer 13

pupil anomalies
optic neuritis
iritis/uveitis
blindness

Question 14

__ involvement is common in secondary syphilis, but ___.

Answer 14

hepatic

asymptomatic

Question 15

Latent syphilis is defined with positive __, normal __, and no __ in an ___ patient.

Answer 15

serology
CSF
symptoms
treated

Question 16

Symptomatic neurosyphilis is more common in __ patients with low __ count.

Answer 16

HIV

CD4

Question 17

Neurosyphilis will present differently accordingly to the years passed and affected areas:
meningeal-

Answer 17

one year
10 years
20
25-30

Question 18

What does general paresis include?

Answer 18

Personality
Affect
Reflexes
Eyes
Sensorium 
Intellect 
Speech

Question 19

Tabes dorsalis is caused by de-___ of the __ column. __ roots, and __ of the spinal cord

Answer 19

myelination
posterior
dorsal
DRG (dorsal root ganglion)

Question 20

Late syphilis may affect the __ system (__). Late benign syphilis may result in __ of the nasal/buccal cavity

Answer 20

cardio-vascular
endarteritis obliterans
perforation

Question 21

Congenital disease can be prevented by treatment before the __ week

Answer 21

16th

Question 22

Early symptoms of congenital syphilis include __, __/__ lesions, __ disorder, ___, ___, and others…

Answer 22

rhinitis
mucosal/cutaneous
bone
hepatosplenomegaly
lymphadenopathy

Question 23

Congenital syphilis leads to interstitial ___, damage to the 8th cranial nerve->__, destruction of __/__ barrier due to periostitis.

Answer 23

keratitis
deafness
mouth/nasal

Question 24

What is the classic stigmata of congenital syphilis? 4

Answer 24

Hutchinson’s teeth
mulberry molars
saddle nose
saber shins

Question 25

What is the DDx for congenital syphilis?

Answer 25

rubella 
CMV
HSV
toxoplasma
erythroblastosis fetalis

Question 26

Syphilis cannot be cultured, so diagnosis is done with the following:

Answer 26

VDRL and RPR

TPPA and FTA-ABS

Question 27

Lymphoid examination (VDRL/RPR) measure the levels of __ and __ for ___.

Answer 27

IgG
IgM
cardiolipin-licitin-cholesterol

Question 28

RPR is a more __ exam, but VDRL is the gold standard for __

Answer 28

convenient

CSF

Question 29

The lymphoid examinations are both good for follow up. When treating- the levels should decrease in __ folds.

Answer 29

4

Question 30

Treponemal tests (TPPA and FTA-ABS) are used for __ the diagnosis.

Answer 30

confirm

Question 31

Patients with RPR titer >: or HIV patients with CD4

Answer 31

1:32
350
neurosyphilis

Question 32

Screening for neurosyphilis is based on __: 3

Answer 32

LP
pleocytosis mononuclear (>5, >20 in HIV)
elevated protein (>45)
reactive VDRL

Question 33

Treatment for primary/secondary/early latent/prevention post exposure + abnormal CSF:

Answer 33

single dose of penicillin IM
if allergic-
tetracycline/doxycycline for 2 weeks

Question 34

Treatment for late latent syphilis:

Answer 34

1 a week X 3 of penicillin IM
if allergic-
HIV (-): tetracycline/doxycycline for 4 weeks
HIV (+): desensitization for penicillin

Question 35

Treatment for neurosyphilis:

Answer 35

penicillin IV for 10-14 days 
or
penicillin IM + probenecid
if allergic- 
desensitization for penicillin

Question 36

Jarisch Herxheimer reaction=___, self-__ reaction that appear after we start __. Appears in __% of primary syphilis and __% of secondary. Most likely caused by particles released from dead bacteria.

Answer 36

dramatic
limiting 
treatment
50
90

Question 37

Jarisch Herxheimer reaction is characterized by: 5

Answer 37

fever+ chills
myalgia
headache
tachycardia + elevated RR
leukocytosis

Question 38

What is the management of Jarisch Herxheimer reaction?

Answer 38

warn the patient and treat symptomatically