A 24-Year-Old Man Comes to the Urgent Care Clinic with a Penile

question 763

Multiple Choice

A 24-year-old man comes to the urgent care clinic with a penile lesion that appeared a week ago as a painful papule and has since changed and worsened.  The patient regularly uses intravenous heroin and had unprotected sex with a female acquaintance in exchange for a small amount of heroin 2 weeks ago.  He has no history of sexually transmitted infections.  Temperature is 36.7 C (98 F) , blood pressure is 120/70 mm Hg, and pulse is 78/min.  Cardiopulmonary examination is normal.  The abdomen is soft and nontender.  Genital examination reveals a tender, 1.5-cm ulcer on the prepuce with well-demarcated, undermined borders and a purulent exudate.  Two smaller ulcers with a similar appearance are near the larger ulcer.  He has no penile discharge and the scrotum appears normal.  Several inguinal lymph nodes are enlarged and tender.  Skin examination shows track marks in the antecubital area but no other rash.  Which of the following is the most likely cause of this patient's penile ulcer?

• A)Acute HIV infection
• B)Haemophilus ducreyi infection
• C)Neisseria gonorrhoeae infection
• D)Primary syphilis
• E)Staphylococcal ecthyma

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Definitions:

Bodily Illusions

False perceptions or misinterpretations of one’s own body parts or bodily sensations.

Antisocial Personality Disorder

Antisocial Personality Disorder is a mental health condition characterized by a long-term pattern of manipulating, exploiting, or violating the rights of others.

DSM-5 Diagnosis

DSM-5 Diagnosis refers to the use of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, for diagnosing and classifying mental disorders.

Substance-Related Disorder

A range of disorders that involve the excessive use of or dependence on addictive substances, including drugs and alcohol.