USMLE Forum Archives - USMLE Step 3 - INT MED
INT MED
bingousmle - 07-27-10 01:29
A 24-year-old man seeks evaluation for painless penile ulcerations. He noted the first lesion about 2 weeks ago, and since that time, two adjacent areas have also developed
ulceration. He returned 5 weeks ago from a vacation in Brazil where he did have unprotected sexual intercourse with a local woman . He was last tested for HIV 2 years ago. He has never had a chlamydial or gonococcal infection. On examination, there are three welldefined red, friable lesions measuring 5 mm or less on the penile shaft. They bleed easily with any manipulation. There is no pain with palpation. There is shotty inguinal lymphadenopathy. On biopsy of one lesion, there is a prominent intracytoplasmic inclusion of bipolar organisms in an enlarged mononuclear cell. Additionally, there is epithelial cell proliferation with an increased number of plasma cells and few neutrophils. A rapid plasma reagin test is negative. Cultures grow no organisms. What is the most likely causative organism?
A. Calymmatobacterium granulomatis (donovanosis)
B. Chlamydia trachomatis (lymphogranuloma venereum)
C. Haemophilus ducreyi (chancroid)
D. Leishmania amazonensis (cutaneous leishmaniasis)
E. Treponema pallidum (secondary syphilis
bingousmle - 07-27-10 01:29
A 24-year-old man seeks evaluation for painless penile ulcerations. He noted the first lesion about 2 weeks ago, and since that time, two adjacent areas have also developed
ulceration. He returned 5 weeks ago from a vacation in Brazil where he did have unprotected sexual intercourse with a local woman . He was last tested for HIV 2 years ago. He has never had a chlamydial or gonococcal infection. On examination, there are three welldefined red, friable lesions measuring 5 mm or less on the penile shaft. They bleed easily with any manipulation. There is no pain with palpation. There is shotty inguinal lymphadenopathy. On biopsy of one lesion, there is a prominent intracytoplasmic inclusion of bipolar organisms in an enlarged mononuclear cell. Additionally, there is epithelial cell proliferation with an increased number of plasma cells and few neutrophils. A rapid plasma reagin test is negative. Cultures grow no organisms. What is the most likely causative organism?
A. Calymmatobacterium granulomatis (donovanosis)
B. Chlamydia trachomatis (lymphogranuloma venereum)
C. Haemophilus ducreyi (chancroid)
D. Leishmania amazonensis (cutaneous leishmaniasis)
E. Treponema pallidum (secondary syphilis
The correct answer and explanation will be available after you answer.
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#1
Re: INT MED babbu5508 - 07-27-10 03:02 My answer is: a.
The diagnosis is based on the patient's sexual history and on physical examination revealing a painless, "beefy-red ulcer" with a characteristic rolled edge of granulation tissue.Tissue biopsy and Wright-Giemsa stain is used to aid in the diagnosis. The presence of Donovan bodies in the tissue sample confirms donovanosis.
#2
Re: INT MED
bingousmle - 07-27-10 14:23 My answer is: a.
the typical presence of inguinal lymphadenopathy with the finding of donovan bodies which are mononuclear cells with safety pin shaped organisms
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