A 34-Year-Old Man Comes to the Office Due to a Painless

question 46

Multiple Choice

A 34-year-old man comes to the office due to a painless penile ulcer, which he first noticed 3 days ago.  He had unprotected sexual intercourse with a new partner a few weeks ago.  The patient has no significant medical history and takes no medications.  Temperature is 37.1 C (98.8 F) .  Examination reveals a 2-cm nontender ulcer close to the glans penis with a raised, indurated margin and a clean base.  There are no surrounding lesions or vesicles.  There are several bilateral enlarged inguinal lymph nodes, which are firm, nontender, and rubbery.  Physical examination is otherwise unremarkable.  Rapid plasma reagin and HIV testing are negative.  Infection with which of the following is the most likely cause of this patient's symptoms?

• A)Chlamydia trachomatis (L serovars)
• B)Haemophilus ducreyi
• C)Herpes simplex virus
• D)Neisseria gonorrhoeae
• E)Treponema pallidum

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Definitions:

Isotope

Variants of a particular chemical element that differ in neutron number, and consequently in nucleon number, but not in proton number.

Neutrons

Subatomic particles found in the nucleus of an atom, with no electric charge and a mass slightly greater than that of protons.

Carbon

A chemical element with symbol C, known as the basis of all known life on Earth, capable of forming multiple compounds including carbon dioxide and organic materials.

Ca

The chemical symbol for calcium, an element with atomic number 20, essential for living organisms, particularly in cell physiology and bone formation.