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Secondary syphilis — USMLE Step 2 CK MCQ

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ModerateInternal MedicineSecondary syphilisUSMLE Step 2 CK

A 32-year-old African American man comes to the emergency department because of progressive symptoms. History and focused examination are notable for diffuse rash involving palms and soles with generalized lymphadenopathy. Temperature is 98.6°F (37.0°C), blood pressure is 126/78 mmHg, pulse is 84/min, respirations are 16/min, and oxygen saturation is 98% on room air. Physical examination confirms the key finding and shows no unrelated abnormality that would better explain the presentation. Focused laboratory studies and initial testing support the clinical pattern described in the stem. Which of the following is the most likely diagnosis?

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Correct answer: B — Secondary syphilis

The vignette describes Secondary syphilis, supported by diffuse rash involving palms and soles with generalized lymphadenopathy. Secondary syphilis is the single best answer because it matches the diagnostic or management priority in this clinical setting. The other choices are plausible alternatives in related presentations, but they do not best fit the timing, findings, and guideline-directed approach described here.

Reference: CDC STI Treatment Guidelines 2021