[56.1 ] A 19-year-old woman is noted to have a RPR titer of 1:16, and the confirmatory MHA-TP test is positive. She has no history of syphilis. She is treated with benzathine penicillin 2.4 million units intramuscularly. Three months after therapy, she is noted to have an RPR titer of 1:2. The next month (4 months after treatment), the titer is 1:1. Two months later, 6 months after treatment, the repeat RPR is noted to be 1:32. Which of the following is the most likely diagnosis?
A. Resistant organism
B. Inadequately treated syphilis
C. Laboratory error
[56.2J Which of the following statements about Treponema pallidum is correct?
A. It is a protozoan.
B. Gram's stain is a very sensitive method of diagnosis.
C. It causes neonatal disease mainly by direct inoculation of the baby by the genital lesion.
D. Alternative treatments include clindamycin and nitrofurantoin.
[56.3] An 18-year-old Gl PO at 14 weeks' gestation is noted to have a positive RPR with a positive confirmatory MHA-TP test. The patient states that she is allergic to penicillin, with hives and swelling of the tongue and throat occurring in the past. Which of the following is the most appropriate next step?
A. Desensitize and treat with penicillin
B. Oral erythromycin
C. Oral doxycycline
D. Pretreat with prednisone, then administer penicillin
[56.4] A 29-year-old woman is noted to have a persistently elevated RPR titer of 1:32 despite treatment with benzathine penicillin 2.4 million units each week for a total of 3 weeks. She complains of slight dizziness and a clumsy gait of 6 months' duration. Which of the following is the best test for diagnosing neurosyphilis?
A. Plain x-ray films of the skull
C. Computed tomographic scan of the head
D. Lumbar puncture
E. Psychiatric evaluation
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