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 20-year-old male develops multiple tender, bleeding, nonindurated ulcers over the prepuce and glans, which are painful. He also has suppurative lymphadenopathy, presenting 5 days after sexual intercourse with a sex worker. What is the most probable diagnosis?

Chancroid. **Explanation:** The clinical presentation of **multiple, painful, non-indurated (soft) ulcers** with a **short incubation period** (5 days) and **suppurative lymphadenopathy** (buboes) is classic for **Chancroid**, caused by *Haemophilus ducreyi* [1]. **1. Why Chancroid is correct:** * **Ulcer Characteristics:** Unlike Syphilis (which is painless and indurated), Chancroid ulcers are "soft," extremely tender, and bleed easily upon manipulation [1]. * **Lymphadenopathy:** It typically causes unilateral, painful, fluctuant inguinal lymph nodes (buboes) that may rupture spontaneously [1]. * **Incubation:** The short duration (3–7 days) fits the timeline provided [1]. **2. Why other options are incorrect:** * **Lymphogranuloma venereum (LGV):** Caused by *Chlamydia trachomatis* (L1-L3). The primary ulcer is usually small, painless, and transient (often missed) [1]. * **Herpes Genitalis (HSV-2):** Presents as multiple small, grouped vesicles on an erythematous base that rupture to form shallow ulcers. While painful, they do not typically present with large suppurative buboes [1]. * **Molluscum Contagiosum:** Caused by Poxvirus. It presents as painless, pearly, umbilicated papules, not bleeding ulcers or suppurative lymphadenopathy. **Clinical Pearls for NEET-PG:** * **Microscopy:** *H. ducreyi* shows a characteristic **"School of fish"** or "Railroad track" appearance on Gram stain. * **Treatment:** A single dose of **Azithromycin (1g)** or Ceftriaxone (250mg IM). * **Mnemonic:** "He **do cry** because it's painful" (*H. ducreyi*). * **Syphilis vs. Chancroid:** Syphilis = Painless/Hard; Chancroid = Painful/Soft.

Q: A 25-year-old laborer presented 3 years ago with an untreated penile ulcer. Later, he developed neurological symptoms for which he received treatment. What is the test used to monitor the response to treatment?

VDRL. The clinical presentation describes a patient with **Neurosyphilis** (neurological symptoms following an untreated primary penile ulcer). In syphilis management, tests are categorized into **Treponemal** (specific) and **Non-treponemal** (non-specific) tests [1]. **1. Why VDRL is correct:** VDRL (Venereal Disease Research Laboratory) is a non-treponemal test that measures IgG and IgM antibodies against cardiolipin-lecithin-cholesterol antigen. These antibody titers correlate with disease activity. A successful response to treatment is indicated by a **four-fold decline in titers** (e.g., from 1:32 to 1:8). Furthermore, **CSF-VDRL** is the gold standard for diagnosing neurosyphilis and monitoring its resolution. **2. Why other options are incorrect:** * **FTA-ABS (Fluorescent Treponemal Antibody Absorption):** This is a treponemal test. These tests remain positive for life ("immunological memory") regardless of treatment; therefore, they cannot be used to monitor treatment response or distinguish between a new and old infection. * **TPI (Treponema Pallidum Immobilization):** This is a highly specific treponemal test but is technically difficult and rarely used today. Like FTA-ABS, it remains positive for life. * **RPR (Rapid Plasma Reagin):** While RPR is also a non-treponemal test used for monitoring systemic syphilis, **VDRL is the preferred test specifically for Neurosyphilis** (especially in CSF) due to its standardized performance in that medium [1]. **Clinical Pearls for NEET-PG:** * **Screening:** RPR/VDRL [1]. * **Confirmation:** FTA-ABS/TPHA. * **Monitoring/Prognosis:** VDRL titers. * **Prozone Phenomenon:** Can cause false negatives in secondary syphilis due to very high antibody titers [1]. * **Jarisch-Herxheimer Reaction:** An acute febrile reaction seen within 24 hours of starting Penicillin treatment for syphilis.

Q: A patient expresses concern over exposure to sexually transmitted diseases. During a pelvic examination, a singular, indurated, nontender ulcer is noted on the vulva. VDRL and FTA tests are positive. Without treatment, what is the characteristic clinical manifestation of the next stage of this disease?

Macular rash over the hands and feet. **Explanation:** The patient presents with a **painless, indurated ulcer (chancre)** and positive serology (VDRL, FTA-ABS), which is the hallmark of **Primary Syphilis**, caused by *Treponema pallidum* [1]. The question asks for the characteristic manifestation of the **next stage** (Secondary Syphilis). 1. **Why Option D is Correct:** Secondary syphilis occurs 2–10 weeks after the primary chancre heals. It is characterized by systemic dissemination. The most classic finding is a **diffuse maculopapular rash** that characteristically involves the **palms and soles** [1]. Other features include condyloma lata and generalized lymphadenopathy. 2. **Why Other Options are Incorrect:** * **Options A, B, and C** are all manifestations of **Tertiary Syphilis**, which occurs years after the initial infection if left untreated [1]. * **Optic nerve atrophy and generalized paresis (A):** These are late neurosyphilitic complications involving parenchymal brain damage. * **Tabes dorsalis (B):** This involves the slow degeneration of the posterior columns of the spinal cord, leading to ataxia and loss of proprioception. * **Gummas (C):** These are chronic, destructive granulomatous lesions found in the skin, bone, or internal organs during the late stage. **NEET-PG High-Yield Pearls:** * **Primary Syphilis:** Painless chancre + painless regional lymphadenopathy [1]. * **Secondary Syphilis:** "The Great Imitator." Look for palms/soles rash, snail-track ulcers in the mouth, and **Condyloma Lata** (flat-topped warts) [1]. * **Diagnosis:** Dark-field microscopy is the gold standard for primary lesions. VDRL/RPR are screening tests; FTA-ABS is the confirmatory treponemal test. * **Treatment:** **Benzathine Penicillin G** (2.4 million units IM) is the drug of choice for primary and secondary syphilis.

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

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 3

A 20-year-old male develops multiple tender, bleeding, nonindurated ulcers over the prepuce and glans, which are painful. He also has suppurative lymphadenopathy, presenting 5 days after sexual intercourse with a sex worker. What is the most probable diagnosis?

Accepted Answer

Chancroid

Answer

Lymphogranuloma venereum (LGV)

Answer

Herpes genitalis

Answer

Molluscum contagiosum

Question 4

A 25-year-old laborer presented 3 years ago with an untreated penile ulcer. Later, he developed neurological symptoms for which he received treatment. What is the test used to monitor the response to treatment?

Accepted Answer

VDRL

Answer

FTA-ABS

Answer

TPI

Answer

RPR

Question 5

A patient expresses concern over exposure to sexually transmitted diseases. During a pelvic examination, a singular, indurated, nontender ulcer is noted on the vulva. VDRL and FTA tests are positive. Without treatment, what is the characteristic clinical manifestation of the next stage of this disease?

Accepted Answer

Macular rash over the hands and feet

Answer

Optic nerve atrophy and generalized paresis

Answer

Tabes dorsalis

Answer

Gummas

Venerology — MCQs

Venerology — MCQs

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