American Board of Internal Medicine (ABIM) Certification Practice Exam

What syndrome is characterized by an ulcerative lesion with a central eschar and localized tender lymphadenopathy?

1. Mycobacterium marinum infection

2. West Nile neuroinvasive disease

3. Ulceroglandular syndrome

4. Anti-NMDAR antibody encephalitis

The correct answer is: Ulceroglandular syndrome

The syndrome characterized by an ulcerative lesion with a central eschar and localized tender lymphadenopathy is known as ulceroglandular syndrome. This condition typically arises from an infection with the bacterium Francisella tularensis, which causes tularemia. The ulcerative lesion occurs at the site of infection, often after exposure to an infected animal or contaminated environment. The central eschar represents necrotic tissue at the site of the ulcer, and the localized lymphadenopathy indicates that the regional lymph nodes are responding to the infection, becoming swollen and tender as they filter the bacteria. In contrast, the other conditions listed, while notable, do not correspond to this particular presentation. Mycobacterium marinum infections typically present differently, often resembling granulomas rather than ulcers with eschar. West Nile neuroinvasive disease primarily affects the central nervous system and does not present with localized ulcerative lesions or lymphadenopathy as its main feature. Anti-NMDAR antibody encephalitis involves neuropsychiatric symptoms and does not manifest with skin ulcers or lymph node involvement. Hence, the defining characteristics of ulceroglandular syndrome make it the correct answer for this clinical presentation.