Venerology Practice Questions

Q: Which of the following is NOT a feature of chancroid?

Typically indurated ulcer. **Chancroid** is a sexually transmitted infection caused by the Gram-negative coccobacillus ***Haemophilus ducreyi***. Understanding its clinical presentation is crucial for differentiating it from Syphilis (the "Great Mimicker"). ### Why Option D is Correct The hallmark of Chancroid is a **non-indurated** (soft) ulcer. In contrast, **induration** (firmness/hardness at the base) is the classic feature of a **Hard Chancre** seen in Primary Syphilis (*Treponema pallidum*). Because Chancroid lacks this firmness, it is often referred to as a "Soft Chancre." ### Explanation of Incorrect Options * **A. Ulcer bleeds easily:** Chancroidal ulcers have a friable base covered with a gray or yellow purulent exudate. When the base is scraped or touched, it bleeds easily. * **B. Painful ulcer:** This is the most important clinical differentiator from Syphilis. Chancroid ulcers are **exquisitely painful**, whereas Syphilitic chancre is typically painless. * **C. Bubo formation:** In about 50% of cases, patients develop painful, inflammatory inguinal lymphadenopathy. These can become fluctuant and are termed **buboes**, which may rupture spontaneously. ### NEET-PG High-Yield Pearls * **School of Fish Appearance:** On Gram stain, *H. ducreyi* shows a characteristic "railroad track" or "school of fish" arrangement. * **The "P" Rule:** Remember **Chancroid = Painful** (both the ulcer and the lymph nodes). * **Autoinoculation:** Multiple ulcers are common in Chancroid due to autoinoculation ("kissing ulcers"). * **Treatment:** The CDC recommended treatment is a single dose of **Azithromycin (1g orally)** or Ceftriaxone (250mg IM).

Q: A young male presents with painless induration of the penis and enlarged, non-tender genital lymph nodes. What is the most likely cause?

Primary syphilis. ### Explanation The clinical presentation of a **painless, indurated ulcer** (chancre) [2] associated with **painless, non-tender regional lymphadenopathy** is the classic hallmark of **Primary Syphilis**, caused by the spirochete *Treponema pallidum*. #### Why Primary Syphilis is Correct: * **The Chancre:** It typically begins as a papule that erodes into a clean-based ulcer. The key diagnostic feature is **induration** (a button-like firmness) and the complete **absence of pain** [2]. * **Lymphadenopathy:** The associated inguinal lymph nodes are typically bilateral, firm, discrete, and characteristically **painless** (often referred to as "shotty" nodes) [2]. #### Why Other Options are Incorrect: * **Chancroid (*Haemophilus ducreyi*):** Presents with a **painful**, soft ulcer with ragged edges. The associated lymphadenopathy (bubo) is also exquisitely painful and may suppurate. * **Herpes Genitalis (HSV-2):** Presents as multiple, small, **painful vesicles** on an erythematous base that rupture to form shallow ulcers [1]. It is often associated with systemic symptoms (fever, malaise). * **Donovanosis (Granuloma Inguinale):** Caused by *Klebsiella granulomatis*. It presents as beefy-red, velvety, **painless** ulcers that bleed easily on touch. Crucially, there is **no true lymphadenopathy**, though "pseudobuboes" (subcutaneous granulation tissue) may occur. #### NEET-PG High-Yield Pearls: * **Gold Standard Diagnosis:** Dark-field microscopy (shows corkscrew motility of spirochetes). * **Screening vs. Confirmatory:** VDRL/RPR are non-specific screening tests; FTA-ABS/TPHA are specific treponemal confirmatory tests. * **Treatment of Choice:** Benzathine Penicillin G (2.4 million units IM, single dose). * **Jarisch-Herxheimer Reaction:** An acute febrile reaction occurring within 24 hours of starting penicillin treatment for syphilis.

Q: A 35-year-old sailor presents with painful, flocculent masses in his groin. Physical examination reveals multiple enlarged, abscessed lymph nodes with draining indolent sinuses. The patient recalls a prior small papular lesion on his penis that resolved spontaneously. What is the most likely diagnosis?

Lymphogranuloma venereum. ### **Explanation** The clinical presentation is classic for **Lymphogranuloma venereum (LGV)**, caused by *Chlamydia trachomatis* serovars L1, L2, and L3 [1]. **1. Why the correct answer is right:** LGV typically progresses through three stages [1]. The patient’s history of a **painless, self-healing primary papule** (Stage 1) followed by the development of painful, fluctuant inguinal lymphadenopathy (Stage 2) is pathognomonic [1]. The "flocculent masses" and **draining indolent sinuses** represent ruptured "buboes." A key diagnostic feature often mentioned in exams is the **"Groove sign,"** where the inguinal ligament divides the matted lymph nodes [1]. **2. Why the incorrect options are wrong:** * **Condyloma acuminatum:** Caused by HPV 6 and 11; presents as painless, cauliflower-like warts, not abscessed lymph nodes [3]. * **Granuloma inguinale (Donovanosis):** Caused by *Klebsiella granulomatis*. It presents as **painless**, beefy-red ulcerative lesions that bleed on touch. It lacks true lymphadenopathy (presents with "pseudobuboes") [1]. * **Herpes virus infection (HSV-2):** Presents with multiple, painful, grouped vesicles on an erythematous base [2]. While it causes lymphadenopathy, it does not typically lead to fluctuant, draining buboes or indolent sinuses. **3. NEET-PG High-Yield Pearls:** * **Organism:** *Chlamydia trachomatis* (L1-L3). * **Drug of Choice:** Doxycycline (100 mg BID for 21 days). Erythromycin is the alternative for pregnant patients. * **Diagnostic Sign:** **Groove Sign of Greenblatt** (inguinal ligament indentation). * **Histology:** Stellated abscesses (star-shaped necrosis) within the lymph nodes [1]. * **Late Complication:** "Esthiomene" (chronic hypertrophic ulceration and edema of external genitalia) [1].

Question 1

Which of the following is NOT a feature of chancroid?

Accepted Answer

Typically indurated ulcer

Answer

Ulcer bleeds easily

Answer

Painful ulcer

Answer

Bubo formation

Question 2

A young male presents with painless induration of the penis and enlarged, non-tender genital lymph nodes. What is the most likely cause?

Accepted Answer

Primary syphilis

Answer

Chancroid

Answer

Herpes genitalis

Answer

Donovanosis

Question 3

What is the worldwide accepted minimum dose of penicillin for latent syphilis?

Accepted Answer

7.0 million units

Answer

4.8 million units

Answer

6.0 million units

Answer

10 units

Question 4

What is the recommended treatment for secondary syphilis?

Accepted Answer

Benzathine penicillin G 2.4 million units intramuscularly single dose

Answer

Benzathine penicillin G 2.4 million units intramuscularly weekly for 3 doses

Answer

Benzathine penicillin G 2.4 million units intramuscularly twice weekly for 4 doses

Answer

Benzathine penicillin G 2.4 million units intramuscularly twice daily for 2 weeks

Question 5

A 35-year-old sailor presents with painful, flocculent masses in his groin. Physical examination reveals multiple enlarged, abscessed lymph nodes with draining indolent sinuses. The patient recalls a prior small papular lesion on his penis that resolved spontaneously. What is the most likely diagnosis?

Accepted Answer

Lymphogranuloma venereum

Answer

Condyloma acuminatum

Answer

Granuloma inguinale

Answer

Herpes virus infection

Venerology — MCQs

Venerology — MCQs

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