00:01
The secondary syphilis.
00:03
A couple of things that you
very much want to keep in mind
with secondary syphilissyphilis that
you will not find with primary.
00:09
First, it’s five weeks
after primary lesion.
00:14
Go in odd numbers. We
have three and five.
00:18
Three weeks after the
lesion will be primary.
00:20
Five weeks after the primary
would be secondary.
00:23
What are you going to
find in secondary?
Proliferation of spirochete
and the skin and the mucous
membrane become involved.
00:30
Skin is huge.
00:32
And the reason I say
skin is in the picture.
00:34
You’ll find these lesions
on the palms and the soles.
00:40
Secondary syphilis.
00:41
You will not find
this is in primary.
00:44
Most likely.
00:46
Moist areas are also where you
would find these lesions.
00:50
You’re thinking about the
axilla or anogenital region,
and then the mucous membranes
include your mouth, the
throat, the vagina.
00:57
All part of your
syphilitic secondary type.
01:01
Primary and secondary,
keep them separate.
01:05
The tertiary would be five years
or more after initial infection.
01:11
So now, the number that
you want to know for sure
or your area code is 3-5-5.
01:16
Three weeks for primary.
01:19
Five weeks after the
primary for secondary.
01:23
Five years after, you
then develop tertiary.
01:28
This is the one that you have
probably seen many times in --
Well, we’ve talked about
this in cardiology
and you’ve also talked about
this in neuroscience,
with something called
tabes dorsalis.
01:39
When did we talk about
this in cardiology?
I gave you that murmur in which
you’d find the murmur by the third
intercostal space, left parasternal.
01:47
What is that?
Remember, please, if the small blood vessels are being involved
by proliferative endarteritis and they’re obliterated, we call this what in tertiary syphilis?
Endarteritis obliterans.
01:59
If you knock out the endarteries vasa vasorum of the aorta,
the aorta dilates and we call this syphilitic aortitis.
02:08
This typically occurs in the ascending thoracic aorta
which causes aortic valve regurgitation
and a murmur.
02:16
The coronary arteries may also become involved.
02:20
What kind of murmur
did I give you?
I gave you an early
diastolic murmur,
heard best third intercostal
space, left parasternal.
02:27
When you have aortitis, what
kind of murmur would that be?
It has to be aortic regurg.
02:32
Aortic regurg and early
diastolic murmur.
02:35
In addition, neurosyphilis,
what does that refer to?
It refers to your
tabes dorsalis.
02:41
What does tabes
dorsalis mean to you?
What’s the dorsum aspect
of the spinal cord?
What kind of column or path is that
then transmitting up into the head?
That’s correct.
02:51
You have your dorsal column.
02:52
And so therefore, you’re not
going to have propioception.
02:55
You close your eyes,
you try to stand still,
but oh, you’re wobbling.
03:00
Positive Romberg.
03:02
Or you can’t -- proper touch and
proper vibration, right?
That’s all part of
tabes dorsalis.
03:10
Remember neuroscience.
03:12
Benign tertiary syphilis.
03:14
Inflammation of what’s
known as a gumma.
03:15
You might want to think of this
as being a granuloma-like,
okay?
Inflammation of a gumma in skin
and bone and mucous membrane
to perhaps try to
imprison your organism.
03:27
Primary, secondary, tertiary
syphilis are key points
that you make sure that you
know before taking your boards.
03:37
Congenital syphilis.
03:38
What does this mean to you?
Remember, please, that this
is part of your TORCH.
03:42
Vertical transmission,
occurs when an organism crosses
the placenta to infect the fetus.
03:48
With congenital manifestations,
you divide this into
the early portion
or the infantile
and you turn this into
what’s known as your late.
03:55
Early on, you’d expect
to find skin rash,
skeletal abnormalities.
04:00
You might have heard of something
called your saber shin.
04:07
If you haven’t heard
of it, that’s fine,
because they won’t
put saber shin.
04:12
What they will say or
what they will describe
is the anterior curvature
of your tibia, okay?
Think about the tibia.
04:20
It should be nice and
straight obviously,
but if you’d find an anterior curvature
of it, you call that a saber shin.
04:26
Look for that please.
04:29
Late,
tardive.
04:31
We have Hutchinson's triad.
04:33
Notched incisors,
we have insterstitial
keratitis with blindness,
deafness from 8th
cranial nerve injury.
04:42
Remember once again this is
called Hutchinson's triad.
04:45
You might have even heard
of Hutchinson's teeth.
04:48
Notched. What does
that mean to you?
Well these look like pegs
of the central incisors.
04:53
Pegs of what?
A fence.
04:55
If you try to build a fence,
the bottom of wood looks
like it’s notched
so that you can dig
it into the ground or
literally inject it
into the ground.
05:05
These are called
notched incisors.
05:07
Definitely pay
attention to that.
05:09
Then, we have what’s known
as interstitial keratitis.
05:11
Where are you?
The conjunctiva
And deafness from the 8th
cranial nerve injury.
05:17
This is all part of your tardive
type of congenital syphilis.
05:22
You definitely want to know this
and once again be able to organize
it into early and late, tardive.