Sexually transmitted infections: cardiovascular syphilis: practice question

A Dermatology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Dermatology · Sexually transmitted infections: cardiovascular syphilis

Sample item

A 55-year-old man treated inadequately for syphilis in youth has chest discomfort and a diastolic murmur. The chest radiograph shows a dilated ascending aorta with thin linear calcification. What is the underlying pathology?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Obliterative endarteritis of the vasa vasorum causing medial necrosis

Tertiary cardiovascular syphilis involves the ascending aorta. Plasma-cell rich inflammation and endarteritis of the vasa vasorum cause ischaemic medial necrosis, scarring, a tree-bark intima, aneurysm and dilated aortic root with aortic regurgitation. It appears 10 to 30 years after infection.

Option by option

  • A. Atherosclerotic plaque rupture in the descending aorta

    Atherosclerosis typically affects the abdominal aorta and does not preferentially dilate the ascending aorta with linear calcification.

  • B. Fibrillin defect with cystic medial degeneration

    A fibrillin defect gives Marfan syndrome, with young age and skeletal features.

  • C. Obliterative endarteritis of the vasa vasorum causing medial necrosis (correct)

    Correct. Vasa vasorum endarteritis leads to medial scarring and ascending aortic aneurysm.

  • D. Immune complex deposition on the aortic valve

    Immune complex valve disease is typical of rheumatic or lupus endocarditis, not an aneurysm.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Dermatology question

What is the answer to this Dermatology question?

The best answer is C, Obliterative endarteritis of the vasa vasorum causing medial necrosis. Tertiary cardiovascular syphilis involves the ascending aorta.

Why is "Atherosclerotic plaque rupture in the descending aorta" not the answer?

Atherosclerosis typically affects the abdominal aorta and does not preferentially dilate the ascending aorta with linear calcification.

Why is "Fibrillin defect with cystic medial degeneration" not the answer?

A fibrillin defect gives Marfan syndrome, with young age and skeletal features.

Why is "Immune complex deposition on the aortic valve" not the answer?

Immune complex valve disease is typical of rheumatic or lupus endocarditis, not an aneurysm.

What concept does this question test?

It tests Sexually transmitted infections: cardiovascular syphilis in Dermatology. Plasma-cell rich inflammation and endarteritis of the vasa vasorum cause ischaemic medial necrosis, scarring, a tree-bark intima, aneurysm and dilated aortic root with aortic regurgitation. It appears 10 to 30 years after infection.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Sexually transmitted infections: cardiovascular syphilis?

Learn each condition by its primary lesion, site and signature sign. Then use the flashcards and the other Dermatology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.