Repeated USMLE Questions Step 1- 272

A 42-year-old man complains of rash and itching. He has no fever, headache or myalgia. On examination, there is maculopapular rash on the abdomen, palms of the hands and soles of the foot. There are also hypertrophic wart-like lesions around the anal area. Cervical, occipital and inguinal lymph nodes are enlarged. CBC shows marked increase in lymphocytes.

What is the most appropriate laboratory test to confirm his diagnosis?

A-Nucleic acid amplification test for chlamydia

B- Serology for Human papilloma virus

C-VDRL for syphilis

D-Biopsy of the anal lesions

E-Stool and urine analysis


This patient most probably has secondary syphilis characterized by rash involving palms of the hands and soles of the feet. It is also characterized by condyloma lata, which are hypertrophic wart-like lesions and specific for syphilis. VDRL test is positive in all cases of secondary syphilis.

The correct answer is C

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