American Board of Internal Medicine (ABIM) Certification Practice Exam

What should be done for patients with syphilis of unknown duration and an abnormal neurologic exam?

1. Start treatment immediately

2. Refer to an infectious disease specialist

3. Conduct cerebrospinal fluid analysis

4. Perform a CT scan of the brain

The correct answer is: Conduct cerebrospinal fluid analysis

In the case of patients with syphilis of unknown duration who are also presenting with an abnormal neurologic exam, conducting cerebrospinal fluid (CSF) analysis is essential for several reasons. Firstly, the presence of neurologic symptoms raises concern for neurosyphilis or other central nervous system (CNS) involvement, which necessitates a thorough assessment to confirm or rule out these conditions. CSF analysis allows for the examination of specific markers associated with syphilis, including the detection of Treponema pallidum, the causative agent of syphilis, as well as measuring the levels of various immunologic components such as protein and white blood cell counts, which can indicate an inflammatory process. Identifying syphilis in the CSF is critical because treatment protocols for neurosyphilis differ from standard syphilis treatment, requiring more intensive therapy. In contrast, while starting treatment immediately might seem advantageous, it is crucial to obtain the CSF analysis to tailor the treatment appropriately, especially in cases where there might be CNS involvement. Similarly, while referral to an infectious disease specialist could be considered beneficial in a complex case, it does not address the immediate need for diagnostic clarification through CSF examination. Lastly, performing a CT