NBME Step 2 CK Form 8 Consistent use of condoms (NBME Answers)

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submitted by ∗step_prep(148)

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Young patient with high-risk sexual behavior who presents with fever, malaise, maculopapular rash over the palms and soles and diffuse lymphadenopathy, which is most consistent with syphilis
Key idea: 3 major infectious causes of rash over the palms and soles can be remembered with CaRS (Coxsackie A, Rickettsia Rickettsii (Rocky Mountain Spotted Fever) and Syphilis)
Important to contrast syphilis and Rocky Mountain Spotted Fever, with syphilis more commonly leading to a maculopapular rash and diffuse lymphadenopathy (with epitrochlear lymphadenopathy basically being pathognomonic) and Rocky Mountain spotted fever commonly leading to a purpuric rash that spreads from the hands/feet to the trunk

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lindasmith462 was anyone else thrown by the fact it only mentioned the rash on the palms and soles? (syphilis starts on the trunk and extends to extremities). Especially since RMSF can START maculopapular and doesn't become purpuric until later (probably after it spread past the hands...) LAD may be more classic in syphilis (but can occur in RMSF) but I'd say its way less likely to have a secondary syphilis to be ONLY on the palms/soles.... +1

kstudy Linda, in reality you would test for both or ask the patient some clarifying questions. But NBME is not reality. NBME world is where you are allowed to only order one lab at a time and receive only part of the results back. +2