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