AANP Family Nurse Practitioner (FNP) Certification ExamAssessmentMedium
A 24-year-old male presents to the clinic with a 3-day history of low-grade fever, malaise, and a 'maculopapular rash' that started on his trunk and spread to his extremities, including his palms and soles. He denies any recent travel but reports unprotected sexual contact with a new partner 2 months ago. On physical examination, diffuse lymphadenopathy is noted. Which of the following diagnostic tests is most appropriate at this time?
- ARapid Plasma Reagin (RPR) test
- BAntinuclear Antibody (ANA) test
- CVaricella-Zoster Virus (VZV) PCR
- DEpstein-Barr Virus (EBV) serology
Show answer & explanationAnswer & explanation
Correct answer: A. Rapid Plasma Reagin (RPR) test
The patient's symptoms, including a generalized maculopapular rash involving palms and soles, low-grade fever, malaise, and diffuse lymphadenopathy, are classic for secondary syphilis. Given the reported unprotected sexual contact, an RPR test is the most appropriate diagnostic test to confirm the diagnosis.
Why the other options are wrong
- B. ANA tests for autoimmune diseases like lupus, which does not fit the acute presentation and rash characteristics.
- C. VZV causes chickenpox and shingles; the rash presentation is not typical for VZV.
- D. EBV causes mononucleosis, which typically presents with fatigue, sore throat, and lymphadenopathy, but a diffuse maculopapular rash on palms and soles is not a hallmark feature.
Secondary Syphilis Diagnosis
Secondary syphilis is a systemic stage of syphilis characterized by a mucocutaneous rash, often involving palms and soles, along with other systemic symptoms like fever, malaise, lymphadenopathy, and sore throat.
- Caused by Treponema pallidum bacterium.
- Rash can be highly variable but frequently involves palms and soles.
- Often follows a chancre (primary stage) by several weeks to months.
Memory trick: Syphilis Spreads Systemically, Showing Skin Signs, Especially Soles and Palms.