A 72-year old woman has increasing shortness of breath with exertion. At present, she is unable to climb even one flight of stairs without stopping to rest and catch her breath. This symptom started over a year ago and has gradually worsened.
The patient is afebrile with a heart rate of 110/min and a blood pressure of 180/70 mmHg. Cardiac examination reveals a loud diastolic murmur heard along the left sternal border consistent with aortic valve regurgitation. The patient was also noted to have firm, non‐inflamed enlargements of the knees (below). A neurological examination revealed decreased vibratory and light touch sensation in the feet, and the patient was noted to slap her feet on the ground when she walked.
a. This patient likely has syphilis. Explain the complications and why the patient was not previously diagnosed. (2 points)
b. Explain the patient’s clinical presentation with an enlarged knee. What is the pathogenicity (cause) of this condition associated with the etiological agent? (2 points)
c. List one specific test method that would be useful in the final confirmatory diagnosis for this patient. (1 point)