Venerology Practice Questions

Q: In acquired syphilis, what is the characteristic lesion that develops in the primary stage?

The characteristic lesion is a chancre, a painless ulcer.. ***The characteristic lesion is a chancre, a painless ulcer [1].*** - The **chancre** is the hallmark lesion of **primary syphilis**, developing at the site of *Treponema pallidum* entry [1]. - It is a **painless, indurated ulcer with raised borders**, typically occurring 10-90 days after exposure and resolving spontaneously. *The infection is most infectious in the secondary stage.* - While primary syphilis with its chancre is infectious, the **secondary stage is characterized by widespread dissemination of spirochetes**, making it the most infectious stage [1]. - The **maculopapular rash** and **condylomata lata** of secondary syphilis contain a high bacterial load [1]. *Causes secondary uveitis.* - **Uveitis** can occur in syphilis, but it is more characteristic of **secondary syphilis**, not primarily associated with the primary stage lesion itself. - Ocular involvement in secondary syphilis can include **uveitis**, retinitis, and optic neuritis, due to systemic dissemination. *Interstitial keratitis is a recognized feature of tertiary syphilis.* - **Interstitial keratitis** is typically a manifestation of **congenital syphilis** or sometimes late **tertiary syphilis**, not a primary stage presentation. - It involves inflammation of the cornea without primary involvement of the epithelium or endothelium, leading to vision impairment.

Q: A 27-year-old white man presents to his family doctor complaining of being tired all the time and having a slight fever for the past two weeks, following a recent trip to Las Vegas. His physical examination is unremarkable, except for a macular rash over his trunk and on the palms of his hands, with no lesions or ulcers on the penis. What is the causative organism of this man's illness?

Treponema pallidum. ***Treponema pallidum*** - The patient's symptoms, including **fatigue**, **low-grade fever**, and a **macular rash on the trunk and limbs that may later involve the palms and soles** [1], are classic manifestations of **secondary syphilis**, caused by *Treponema pallidum*. - Although there are no genital lesions currently, the rash and systemic symptoms are highly suggestive of disseminated infection following an untreated primary chancre. *Chlamydia trachomatis* - This bacterium is a common cause of **urethritis**, **cervicitis**, and **lymphogranuloma venereum**, but it does not typically cause a diffuse macular rash on the trunk and palms. - While it can cause systemic symptoms in some cases (e.g., reactive arthritis), the described rash is not characteristic. *Neisseria gonorrhoeae* - This organism primarily causes **gonorrhea**, presenting as urethritis with purulent discharge, cervicitis, or pelvic inflammatory disease; it can also cause disseminated gonococcal infection. - Disseminated gonococcal infection can cause rash, but it is typically **pustular or vesiculopustular**, often on extremities, and not the diffuse macular rash described. *Borrelia burgdorferi* - This spirochete is the causative agent of **Lyme disease**, transmitted by ticks. - The classic rash of Lyme disease is **erythema migrans** (a bull's-eye rash), which is distinct from the macular trunk and palm rash seen in this patient.

Q: The most appropriate diagnostic test for a 23-year-old male who had unprotected sexual intercourse with a commercial sex worker, developed a painless, indurated ulcer on the glans that exudes clear serum on pressure, and has enlarged and non-tender inguinal lymph nodes in both groins is:

Darkfield microscopy of ulcer discharge. ***Darkfield microscopy of ulcer discharge*** - This patient's presentation with a **painless, indurated ulcer (chancre)** exuding clear serum, coupled with **bilateral non-tender inguinal lymphadenopathy**, is classic for **primary syphilis** [1]. - **Darkfield microscopy** directly visualizes the spirochete *Treponema pallidum* from the chancre exudate, providing a rapid and definitive diagnosis [1]. *Gram stain of ulcer discharge* - **Gram stain** is not an effective method for identifying *Treponema pallidum* because spirochetes are too thin to be seen with this technique. - It would be more useful for bacterial infections like chancroid (caused by *Haemophilus ducreyi*), which typically presents with a **painful ulcer**. *Giemsa stain of lymph node aspirate* - While Giemsa stain can be used to identify some microorganisms, it is not the primary diagnostic test for syphilis from a lymph node aspirate. - Lymphogranuloma venereum (LGV) can cause significant lymphadenopathy, and a Giemsa stain might show **chlamydial inclusions**, but the ulcer characteristics are not consistent with LGV. *ELISA for HIV infection* - While unprotected sexual intercourse increases the risk of **HIV infection**, an ELISA test for HIV would detect antibodies, which take several weeks to develop (window period) [2]. - This test would not directly diagnose the source of the patient's immediate genital ulcer and lymphadenopathy, as HIV infection does not typically cause a painless chancre [2].

Q: Which of the following is NOT a component of the Hutchinson triad?

Mulberry teeth. ***Mulberry teeth*** - This is not a component of the **Hutchinson triad**. While it is a dental manifestation of **congenital syphilis**, the specific dental feature in the triad is **Hutchinson teeth**. - **Mulberry teeth** (also known as Moon's molars or Fournier's molars) refer to hypoplastic molars with poorly developed cusps, distinct from the notched incisors of Hutchinson teeth. *Interstitial keratitis* - This is a key component of the **Hutchinson triad**, characterized by inflammation of the cornea's interstitial layers. - It often leads to **corneal clouding** and vision impairment. *Eight cranial nerve deafness* - Also known as **sensorineural hearing loss**, this is a critical component of the triad, resulting from damage to the vestibulocochlear nerve. - It typically manifests as **progressive bilateral hearing loss**. *Hutchison teeth* - These are a classic feature of congenital syphilis and a specific component of the triad, characterized by **notched, peg-shaped incisors** that are widely spaced. - They result from enamel hypoplasia caused by the treponemal infection during tooth development.

Q: Which of the following structures is least commonly affected by Neisseria gonorrhoeae infection?

Testis. ***Testis*** - The **testis** is protected by the **blood-testis barrier**, making direct infection with *Neisseria gonorrhoeae* extremely rare without prior epididymitis. - While *N. gonorrhoeae* can cause epididymitis, orchitis (inflammation of the testis) secondary to gonorrhea is an uncommon complication. *Prostate* - **Prostatitis** is a possible complication of disseminated gonococcal infection, though less common than urethritis or epididymitis. - Inflammation results from ascending infection from the urethra, affecting the **prostate gland**. *Epididymis* - **Epididymitis** is a common complication of untreated gonococcal urethritis, particularly in younger sexually active men. - The infection spreads from the urethra to the epididymis via the **vas deferens**, causing pain and swelling. *Urethra* - The **the urethra** is the most commonly affected site in men with gonococcal infection, leading to **gonococcal urethritis**. - Symptoms include **dysuria** and **purulent urethral discharge**.

Q: In gonorrhea, which is not a presenting feature?

Hematuria. ***Hematuria*** - **Hematuria**, or blood in the urine, is not a typical presenting feature of uncomplicated gonococcal infection. - While urinary tract infections can cause hematuria, **gonorrhea primarily affects mucous membranes** of the reproductive and urinary tracts, leading to inflammation and purulent discharge rather than bleeding within the urinary system itself. *Discharge* - **Urethral discharge** in men and **vaginal or cervical discharge** in women is a very common symptom of gonorrhea [1]. - The discharge is typically **purulent, thick, and yellowish-green**. *Dysuria* - **Dysuria**, or painful urination, is a frequent symptom, especially in men with **urethritis** due to gonorrhea [1]. - It results from the **inflammation of the urethra** caused by the bacterial infection. *Reddened lips of vulva and vagina* - **Erythema and inflammation of the vulva and vagina** can occur in women with gonococcal cervicitis or vaginitis [1]. - This irritation is a direct result of the **gonococcal infection** of the mucosal surfaces.

Q: The incubation period of gonorrhoea is

2 to 15 days. The typical incubation period for **gonorrhoea** is **2-7 days in males** and up to **14 days in females**, aligning with **CDC guidelines** for *Neisseria gonorrhoeae* infection. Many cases remain **asymptomatic**, particularly in women, making this timeframe crucial for contact tracing and screening protocols. *Less than 24 hrs* - An incubation period of less than 24 hours is **medically implausible** for bacterial STIs, as it doesn't allow sufficient time for bacterial colonization and host immune response. - Such rapid onset is more characteristic of **toxin-mediated illnesses** or **hypersensitivity reactions**, not bacterial infections. *1 to 2 days* - While theoretically possible with **very high bacterial load** or in highly susceptible individuals, this represents the **absolute minimum** timeframe and is not typical. - The **majority of gonorrhoea cases** develop symptoms beyond this very short window, making it an inadequate representation of the standard incubation period. *12 to 25 days* - This timeframe is **too prolonged** for gonorrhoea and more characteristic of **chlamydia infections**, which have an incubation period of **7-21 days**. [1] - Gonorrhoea typically manifests much earlier due to the **aggressive nature** of *Neisseria gonorrhoeae* compared to other bacterial STIs.

Q: Which of the following infections can cause genital ulcers?

Herpes simplex virus (HSV). ***Herpes simplex virus (HSV)*** - HSV causes **painful, vesicular lesions** on the genitals that can rupture to form **ulcers** [1], [2]. - These infections are known for their recurrent nature and are one of the most common causes of **genital ulcers** [1], [2]. *Human papillomavirus (HPV)* - HPV primarily causes **genital warts** (condylomata acuminata), which are **flesh-colored, cauliflower-like growths**, not ulcers. - While some high-risk HPV types can lead to cervical or other anogenital cancers, they do not directly present as ulcers. *Syphilis (Treponema pallidum)* - Syphilis causes a **painless chancre** in its primary stage, which is a type of ulcer [1]. - However, the question asks which of the given options *can* cause genital ulcers, and HSV is a direct and common cause with the classic presentation of multiple painful ulcers [1]. *Human immunodeficiency virus (HIV)* - HIV itself does not directly cause genital ulcers. - However, it can increase an individual's susceptibility to other infections that do cause ulcers, or worsen the presentation of existing ulcer-causing STIs.

Q: A 40-year-old female presented with numerous, non-itchy, erythematous, scaly papules (lesions) on the trunk, with a few oral white mucosal plaques and erosive lesions in the perianal area. The probable diagnosis is

Secondary syphilis. ***Secondary syphilis*** - **Erythematous, scaly papules** on the trunk (syphilitic roseola or papulosquamous lesions), **oral white mucosal plaques** (mucous patches), and **erosive lesions in the perianal area** (condylomata lata) are classic manifestations of secondary syphilis [1]. - The lesions are typically **non-itchy** and can appear widespread [1]. *Psoriasis* - Psoriasis typically presents with well-demarcated, **erythematous plaques covered with silvery scales**, often on extensor surfaces, and is usually itchy. - While psoriasis can affect mucous membranes, the specific combination of oral white plaques and perianal erosions is less characteristic than in secondary syphilis. *Lichen planus* - Lichen planus typically presents with **pruritic, purple, polygonal, planar papules** and often involves flexural surfaces. - Oral lichen planus can manifest as white reticular patterns (Wickham's striae) or erosions, but the widespread scaly papules on the trunk and perianal erosions observed here are not typical. *Disseminated candidiasis* - Disseminated candidiasis usually occurs in **immunocompromised individuals** and presents with widespread skin lesions, fever, and systemic symptoms. - The skin lesions are typically **macular, papular, or nodular and can be pustular**, but the description of scaly papules, oral white plaques, and perianal erosions is not characteristic of candidiasis.

Q: Higoumenaki sign is suggestive of:

Congenital syphilis. Higoumenaki sign is suggestive of: ***Congenital syphilis*** - The **Higoumenakis sign** is a unilateral or bilateral thickening of the medial third of the **clavicle**, resulting from periostitis and osteitis. - This sign is a classic, though rarely observed, manifestation of **late congenital syphilis**. *Psoriasis* - Psoriasis is a chronic autoimmune skin condition characterized by **red, scaly patches** (plaques), not bone changes like clavicular thickening. - While psoriasis can have musculoskeletal involvement (**psoriatic arthritis**), it does not present with the Higoumenakis sign. *Cholecystitis* - **Cholecystitis** is inflammation of the gallbladder, typically causing acute right upper quadrant abdominal pain, fever, and leukocytosis. - It is an abdominal condition and has no association with clavicular changes or systemic infectious diseases like syphilis. *Tetany* - Tetany is a state of **neuromuscular hyperexcitability** characterized by carpopedal spasm, muscle cramps, and tremors, often due to **hypocalcemia**. - This condition affects muscle and nerve function and does not involve bony changes such as clavicular thickening.

Question 1

In acquired syphilis, what is the characteristic lesion that develops in the primary stage?

Accepted Answer

The characteristic lesion is a chancre, a painless ulcer.

Answer

Causes secondary uveitis.

Answer

The infection is most infectious in the secondary stage.

Answer

Interstitial keratitis is a recognized feature of tertiary syphilis.

Question 2

A 27-year-old white man presents to his family doctor complaining of being tired all the time and having a slight fever for the past two weeks, following a recent trip to Las Vegas. His physical examination is unremarkable, except for a macular rash over his trunk and on the palms of his hands, with no lesions or ulcers on the penis. What is the causative organism of this man's illness?

Accepted Answer

Treponema pallidum

Answer

Chlamydia trachomatis

Answer

Borrelia burgdorferi

Answer

Neisseria gonorrhoeae

Question 3

The most appropriate diagnostic test for a 23-year-old male who had unprotected sexual intercourse with a commercial sex worker, developed a painless, indurated ulcer on the glans that exudes clear serum on pressure, and has enlarged and non-tender inguinal lymph nodes in both groins is:

Accepted Answer

Darkfield microscopy of ulcer discharge

Answer

Gram stain of ulcer discharge

Answer

Giemsa stain of lymph node aspirate

Answer

ELISA for HIV infection

Question 4

Which of the following is NOT a component of the Hutchinson triad?

Accepted Answer

Mulberry teeth

Answer

Hutchison teeth

Answer

Interstitial keratitis

Answer

Eight cranial nerve deafness

Question 5

Which of the following structures is least commonly affected by Neisseria gonorrhoeae infection?

Accepted Answer

Testis

Answer

Prostate

Answer

Epididymis

Answer

Urethra

Question 6

In gonorrhea, which is not a presenting feature?

Accepted Answer

Hematuria

Answer

Discharge

Answer

Reddened lips of vulva and vagina

Answer

Dysuria

Question 7

The incubation period of gonorrhoea is

Accepted Answer

2 to 15 days

Answer

Less than 24 hrs

Answer

1 to 2 days

Answer

12 to 25 days

Question 8

Which of the following infections can cause genital ulcers?

Accepted Answer

Herpes simplex virus (HSV)

Answer

Syphilis (Treponema pallidum)

Answer

Human papillomavirus (HPV)

Answer

Human immunodeficiency virus (HIV)

Question 9

A 40-year-old female presented with numerous, non-itchy, erythematous, scaly papules (lesions) on the trunk, with a few oral white mucosal plaques and erosive lesions in the perianal area. The probable diagnosis is

Accepted Answer

Secondary syphilis

Answer

Psoriasis

Answer

Lichen planus

Answer

Disseminated candidiasis

Question 10

Higoumenaki sign is suggestive of:

Accepted Answer

Congenital syphilis

Answer

Psoriasis

Answer

Cholecystitis

Answer

Tetany

Venerology — MCQs

Venerology — MCQs

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