Venerology — MCQs
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A 25-year-old female presents with pain and tenosynovitis of the wrists and ankles, and arthralgias of other joints. She notes two prior episodes similar to the present one. She had her menstrual period during the previous week. Physical examination reveals ulcerated lesions overlying the wrists and ankles. These symptoms are likely due to deficiency of which of the following?
What is considered successful treatment of chancroid?
A man presents with multiple, painful, indurated, undermined, and sloughed ulcers over the glans penis, which occurred 5 days after exposure. What is the most likely diagnosis?
All of the following are features of a gummatous ulcer EXCEPT?
What is the most likely diagnosis for a patient presenting with a painful ulcer on the glans penis?
Miosis is a component of which syndrome?
Which of the following is not a feature of tertiary syphilis?
Chancroid may be caused by:
What is the characteristic lesion of secondary syphilis?
Which of the following is NOT a characteristic of secondary syphilis?
Venerology Indian Medical PG Practice Questions and MCQs
Question 71: A 25-year-old female presents with pain and tenosynovitis of the wrists and ankles, and arthralgias of other joints. She notes two prior episodes similar to the present one. She had her menstrual period during the previous week. Physical examination reveals ulcerated lesions overlying the wrists and ankles. These symptoms are likely due to deficiency of which of the following?
- A. C1 esterase inhibitor
- B. ciliary function
- C. Complement (C6-C8) components (Correct Answer)
- D. Endothelial adhesion molecules
Explanation: ### Explanation The clinical presentation of **tenosynovitis, arthralgia, and skin lesions** (ulcerated/pustular) in a young female, especially following menstruation, is classic for **Disseminated Gonococcal Infection (DGI)**. **1. Why Option C is Correct:** * **Pathophysiology:** *Neisseria gonorrhoeae* and *Neisseria meningitidis* are pyogenic bacteria that require the **Membrane Attack Complex (MAC)** for effective lysis. The MAC is composed of late complement components **C5, C6, C7, C8, and C9**. * **Deficiency Link:** Patients with inherited deficiencies in these terminal complement components are at a significantly increased risk (up to 10,000-fold) for recurrent systemic neisserial infections. * **Clinical Trigger:** In females, menstruation increases the risk of dissemination from the cervix to the bloodstream due to changes in vaginal pH and mucosal shedding. **2. Why Other Options are Incorrect:** * **A. C1 esterase inhibitor:** Deficiency leads to **Hereditary Angioedema**, characterized by painless, non-pitting edema of the skin and mucosal surfaces (laryngeal edema), not arthritis or pustular rashes. * **B. Ciliary function:** Defects (e.g., Kartagener syndrome) lead to recurrent sinopulmonary infections and situs inversus, not disseminated bacterial arthritis. * **D. Endothelial adhesion molecules:** Defects (e.g., Leukocyte Adhesion Deficiency) present with delayed umbilical cord separation, recurrent skin/mucosal infections without pus, and extreme leukocytosis. **3. NEET-PG High-Yield Pearls:** * **DGI Triad:** Tenosynovitis, Dermatitis (pustules/hemorrhagic macules), and Polyarthralgia. * **Diagnosis:** Blood cultures are often negative; always swab the **cervix, rectum, or pharynx** as the primary site of infection is often asymptomatic [1]. * **Complement Associations:** * **C1, C2, C4 deficiency:** Associated with SLE-like autoimmune diseases. * **C3 deficiency:** Severe, recurrent pyogenic infections (S. pneumoniae, H. influenzae). * **C5-C9 deficiency:** Recurrent Neisserial infections.
Question 72: What is considered successful treatment of chancroid?
- A. Symptomatic improvement occurs within 1 week.
- B. Objective improvement occurs within 1 week. (Correct Answer)
- C. Symptomatic improvement occurs within 2 weeks.
- D. Objective improvement occurs within 2 weeks.
Explanation: Chancroid, caused by the Gram-negative coccobacillus *Haemophilus ducreyi*, is characterized by painful genital ulcers and associated regional lymphadenopathy (buboes). **1. Why Option B is Correct:** According to standard clinical guidelines (including CDC and WHO), successful treatment of chancroid is defined by **objective clinical improvement**—meaning the ulcer shows visible signs of healing (re-epithelialization or decreased size)—within **3 to 7 days (1 week)** after starting effective antibiotic therapy. While pain may improve sooner, the physical resolution of the lesion is the clinical benchmark for success. **2. Why Other Options are Incorrect:** * **Options A & C:** "Symptomatic improvement" refers primarily to the reduction of pain. While pain relief usually occurs within 48–72 hours, it is subjective. Objective physical improvement is the standard metric for confirming treatment efficacy. * **Option D:** A 2-week window is too long for an initial assessment. If no objective improvement is noted within 7 days, clinicians must re-evaluate for a wrong diagnosis, co-infection (e.g., HSV or Syphilis), or antimicrobial resistance. **High-Yield Clinical Pearls for NEET-PG:** * **The "3 Ps" of Chancroid:** **P**ainful, **P**urulent, and **P**unched-out ulcer. * **Microscopy:** "School of fish" or "Railroad track" appearance on Gram stain. * **Treatment of Choice:** Azithromycin (1g orally, single dose) or Ceftriaxone (250mg IM, single dose). * **Bubo Management:** Large, fluctuant buboes should be managed with **needle aspiration**, not incision and drainage, to prevent the formation of chronic draining sinuses. * **Healing Time:** While improvement starts within 1 week, complete healing of large ulcers may take >2 weeks.
Question 73: A man presents with multiple, painful, indurated, undermined, and sloughed ulcers over the glans penis, which occurred 5 days after exposure. What is the most likely diagnosis?
- A. Chancroid (Correct Answer)
- B. Primary chancre
- C. Herpes genitalis
- D. Lymphogranuloma venereum (LGV)
Explanation: ### Explanation The clinical presentation described is classic for **Chancroid**, caused by the Gram-negative coccobacillus *Haemophilus ducreyi*. **1. Why Chancroid is Correct:** The diagnosis is based on the "Four P's" and specific morphology: * **Painful:** Unlike syphilis, these ulcers are exquisitely tender [1]. * **Purulent/Sloughed:** The base is often covered with a greyish-yellow necrotic exudate. * **Punched out/Undermined:** The edges are ragged and undermined. * **Incubation:** A short incubation period (3–7 days) matches the 5-day history provided [1]. * **Induration:** While typically "soft" (soft chancre), chronic or secondary infected ulcers can show induration. **2. Why Other Options are Incorrect:** * **Primary Chancre (Syphilis):** Caused by *Treponema pallidum*. It is characteristically **painless**, single, clean-based, and has a long incubation period (3 weeks). * **Herpes Genitalis (HSV-2):** Presents as multiple, superficial, **vesicular** lesions on an erythematous base [1]. They are painful but usually not indurated or deeply undermined. * **Lymphogranuloma Venereum (LGV):** Caused by *Chlamydia trachomatis* (L1-L3). The primary ulcer is transient, small, and often **painless**, usually disappearing before the patient seeks help for painful inguinal lymphadenopathy (Buboes) [1]. **3. High-Yield Clinical Pearls for NEET-PG:** * **School of Fish Appearance:** Classic description of *H. ducreyi* on Gram stain (railroad track pattern). * **Buboes:** In Chancroid, inguinal lymphadenopathy is usually unilateral and may rupture spontaneously [1]. * **Treatment:** Single dose of **Azithromycin (1g)** or Ceftriaxone (250mg IM). * **Rule of Thumb:** "He **ducreyi** (do cry) because it's painful" (Chancroid), whereas Syphilis is "Sssh-philis" (silent/painless).
Question 74: All of the following are features of a gummatous ulcer EXCEPT?
- A. Punched out edges
- B. Syphilitic in nature
- C. Wash leather slough
- D. Erythematous base (Correct Answer)
Explanation: A **Gummatous ulcer** is a characteristic lesion of **Tertiary Syphilis** (Late Syphilis) [1]. It represents a delayed hypersensitivity reaction to *Treponema pallidum*. ### **Why "Erythematous base" is the correct answer:** The base of a gummatous ulcer is typically **painless, insensitive, and covered with a characteristic slough**, rather than being bright red or erythematous. In contrast, an erythematous base is more characteristic of acute inflammatory or pyogenic ulcers. The gumma is a granulomatous process characterized by endarteritis obliterans, which leads to tissue necrosis and a relatively avascular (pale) appearance of the ulcer bed. ### **Explanation of other options:** * **Punched out edges:** This is a classic morphological feature. The ulcer has vertical, sharply defined walls as if the tissue was removed with a punch tool. * **Syphilitic in nature:** Gummas are the hallmark of benign late syphilis [1]. They can occur in the skin, bone, or internal organs (like the liver). * **Wash leather slough:** This is a pathognomonic description. The floor of the ulcer is covered by a yellowish-white, tough, necrotic material that resembles "wash leather" (chamois). ### **NEET-PG High-Yield Pearls:** * **Site:** Most common on the skin (especially over the pretibial area) and mucous membranes. * **Shape:** Often circular or **serpiginous** (snake-like) when multiple gummas coalesce. * **Pain:** Unlike the primary chancre (which is also painless), the gumma is a deep destructive lesion but remains **painless** unless secondarily infected. * **Healing:** Heals with a characteristic **"Tissue paper scar"** or "Cigarette paper scar" (atrophic, thin, and depigmented). * **Treatment:** Penicillin G is the drug of choice, though gummas are now rare due to early antibiotic intervention.
Question 75: What is the most likely diagnosis for a patient presenting with a painful ulcer on the glans penis?
- A. Syphilis
- B. Lymphogranuloma venerum
- C. Chancroid (Correct Answer)
- D. Chancre
Explanation: The diagnosis of genital ulcers is a high-yield topic for NEET-PG, primarily differentiated by the presence or absence of pain and the characteristics of the lesion. [1] ### **Why Chancroid is Correct** **Chancroid**, caused by the gram-negative coccobacillus *Haemophilus ducreyi*, is classically characterized by a **painful**, "soft" ulcer. [1] The pain is the hallmark clinical feature that distinguishes it from many other STIs. These ulcers often have ragged, undermined edges and a necrotic base (grayish-yellow exudate). They are frequently associated with painful, inflammatory inguinal lymphadenopathy (buboes) which may suppurate. ### **Why Other Options are Incorrect** * **Syphilis (Option A):** Primary syphilis presents as a **painless**, indurated (hard) ulcer with a clean base. [1] * **Chancre (Option D):** This is the clinical term for the primary lesion of syphilis. By definition, a classic chancre is **painless**. * **Lymphogranuloma Venereum (LGV) (Option B):** Caused by *Chlamydia trachomatis* (L1-L3), the primary lesion is a small, transient, **painless** papule or ulcer that often heals unnoticed before the painful "groove sign" (lymphadenopathy) develops. [1] ### **NEET-PG High-Yield Pearls** * **Mnemonic for Pain:** "You **do cry** (*H. ducreyi*) because it's **painful** (Chancroid)." * **School of Fish Appearance:** On Gram stain, *H. ducreyi* shows a characteristic "railroad track" or "school of fish" pattern. * **Donovanosis (Granuloma Inguinale):** Another differential; presents as beefy-red, **painless** ulcers that bleed on touch (pseudo-buboes). [1] Look for "Donovan bodies" (safety-pin appearance) on biopsy. * **Treatment of Chancroid:** Azithromycin (1g orally) or Ceftriaxone (250mg IM).
Question 76: Miosis is a component of which syndrome?
- A. Horner's syndrome (Correct Answer)
- B. Mendelson's syndrome
- C. Turner's syndrome
- D. Klinefelter's syndrome
Explanation: ### Explanation **Correct Option: A. Horner's Syndrome** Horner’s syndrome is caused by a lesion in the **sympathetic pathway** supplying the eye [2], [3]. Since the sympathetic nervous system is responsible for pupillary dilation (via the dilator pupillae muscle), a disruption leads to unopposed parasympathetic action, resulting in **miosis** (constricted pupil) [2]. The classic clinical triad includes: 1. **Miosis** (Pupillary constriction) 2. **Partial Ptosis** (Drooping of the eyelid due to paralysis of Müller’s muscle) [1], [2] 3. **Anhidrosis** (Loss of sweating on the affected side of the face) [3] *Note: Enophthalmos (apparent backward displacement of the eyeball) is often described but is usually an illusion caused by the ptosis.* **Why the other options are incorrect:** * **B. Mendelson's Syndrome:** This is **aspiration pneumonitis** caused by the inhalation of acidic gastric contents, typically occurring during anesthesia. It presents with hypoxia, wheezing, and dyspnea, not pupillary changes. * **C. Turner's Syndrome (45, XO):** A genetic disorder in females characterized by short stature, webbed neck, and primary amenorrhea. * **D. Klinefelter's Syndrome (47, XXY):** A genetic disorder in males characterized by gynaecomastia, small firm testes, and infertility [4]. **High-Yield Clinical Pearls for NEET-PG:** * **Pancoast Tumor:** A common cause of Horner’s syndrome due to involvement of the stellate ganglion (C8-T2). * **Cocaine Test:** In Horner’s syndrome, the pupil **will not dilate** after cocaine drops (which normally block norepinephrine reuptake). * **Apraclonidine Test:** This is the modern diagnostic standard; it causes **mydriasis** in a Horner’s pupil (due to denervation supersensitivity) but has no effect on a normal pupil. * **Wallenberg Syndrome:** A common brainstem cause of Horner's syndrome (Lateral Medullary Syndrome).
Question 77: Which of the following is not a feature of tertiary syphilis?
- A. Gumma
- B. Neurosyphilis
- C. Cardiovascular syphilis
- D. Nephrosyphilis (Correct Answer)
Explanation: **Explanation:** Syphilis, caused by *Treponema pallidum*, progresses through distinct clinical stages [1]. **Tertiary syphilis** (late syphilis) typically occurs years after the initial infection and is characterized by chronic, destructive granulomatous lesions and systemic involvement [1]. **Why Nephrosyphilis is the correct answer:** Renal involvement in syphilis, though rare, is typically a feature of **Secondary Syphilis** or **Congenital Syphilis**, presenting as nephrotic syndrome due to immune-complex mediated glomerulonephritis. It is not a recognized component of the tertiary stage. **Analysis of Incorrect Options:** * **A. Gumma:** These are non-cancerous, granulomatous growths characteristic of late benign syphilis [3]. They commonly affect the skin, bone, and liver. * **B. Neurosyphilis:** While it can occur at any stage, classic late manifestations like **Tabes Dorsalis** (demyelination of posterior columns) and **General Paresis of the Insane** are hallmark features of tertiary syphilis [1]. * **C. Cardiovascular Syphilis:** This occurs due to endarteritis obliterans of the vasa vasorum [1]. The most common manifestation is **Aortitis**, leading to aortic aneurysm (typically ascending aorta) or aortic regurgitation. **High-Yield Clinical Pearls for NEET-PG:** * **Argyll Robertson Pupil:** A classic sign of neurosyphilis where the pupil accommodates but does not react to light ("Prostitute's Pupil"). * **Jarisch-Herxheimer Reaction:** An acute febrile reaction occurring within 24 hours of starting Penicillin treatment for syphilis. * **Drug of Choice:** Benzathine Penicillin G remains the gold standard for all stages of syphilis. * **Screening vs. Confirmatory:** VDRL/RPR are non-specific screening tests; FTA-ABS and TPHA are specific treponemal confirmatory tests [2].
Question 78: Chancroid may be caused by:
- A. T. pallidium
- B. G. donovani
- C. Chlamydia Trachomatis
- D. Herpes Hominis Virus (Correct Answer)
Explanation: ### Explanation **Correct Answer: D. Herpes Hominis Virus** This question highlights a common point of confusion in clinical terminology. While **Chancroid** is classically caused by the bacterium *Haemophilus ducreyi*, the term "chancroidal" or "soft chancre" is often used in a broader clinical context to describe painful genital ulcers [1]. In many standardized examinations, if *H. ducreyi* is absent from the options, **Herpes Hominis Virus** (specifically HSV-2) is the most likely causative agent for painful, non-indurated genital ulcerations [1]. **Analysis of Incorrect Options:** * **A. T. pallidum:** This is the causative agent of **Syphilis**. It typically presents as a "Hard Chancre," which is characterized by a single, painless, indurated ulcer with a clean base. * **B. G. donovani:** *Granuloma donovani* (now *Klebsiella granulomatis*) causes **Granuloma Inguinale (Donovanosis)** [1]. It presents as painless, beefy-red, velvety ulcers that bleed on touch (pseudobuboes). * **C. Chlamydia trachomatis:** Specifically serotypes L1, L2, and L3 cause **Lymphogranuloma Venereum (LGV)** [1]. This presents with a transient, painless primary lesion followed by painful regional lymphadenopathy (the "Groove sign"). **High-Yield Clinical Pearls for NEET-PG:** 1. **Painful vs. Painless:** Remember the mnemonic "H" for Hurt: **H**erpes and **H**aemophilus ducreyi (Chancroid) are **painful** [1]. Syphilis, LGV, and Donovanosis are typically **painless**. 2. **Haemophilus ducreyi:** Look for the "School of fish" or "Railroad track" appearance on Gram stain. 3. **Donovan Bodies:** Pathognomonic for Donovanosis; seen as safety-pin shaped organisms within macrophages on Giemsa stain. 4. **Tzanck Smear:** Used for Herpes; look for multinucleated giant cells and Cowdry Type A inclusion bodies.
Question 79: What is the characteristic lesion of secondary syphilis?
- A. Genital Ulcer
- B. Condyloma acuminata
- C. Dermal tenderness (Correct Answer)
- D. Hutchinson's teeth
Explanation: Syphilis, caused by the spirochete *Treponema pallidum*, is a multi-stage systemic infection. The correct answer is **Dermal tenderness**, which refers to a specific clinical sign often tested in NEET-PG: **Ollendorff’s Sign**. This sign is characterized by exquisite tenderness upon deep pressure on a secondary syphilitic papule using a blunt probe. It is a highly characteristic clinical finding of the secondary stage. **Analysis of Options:** * **A. Genital Ulcer:** This is the hallmark of **Primary Syphilis** (Chancre). The primary chancre is typically a single, painless, indurated ulcer with a clean base [1]. * **B. Condyloma acuminata:** These are "genital warts" caused by **Human Papillomavirus (HPV)** types 6 and 11. In contrast, secondary syphilis presents with **Condyloma lata**, which are flat, moist, wart-like lesions in intertriginous areas [1]. * **D. Hutchinson’s teeth:** This is a component of Hutchinson’s triad, which is a feature of **Late Congenital Syphilis**, not the acquired secondary stage [1]. It involves notched, peg-shaped permanent incisors. **High-Yield Clinical Pearls for NEET-PG:** * **Secondary Syphilis** is known as the "Great Imitator" and is the most florid stage. Common features include a generalized maculopapular rash (involving palms and soles), generalized lymphadenopathy, and mucous patches [1]. * **Lues Maligna:** A severe, pleomorphic form of secondary syphilis seen typically in HIV-positive patients. * **Diagnosis:** Screening is done via non-treponemal tests (VDRL/RPR), while confirmation requires treponemal tests (FTA-ABS/TPHA). * **Treatment:** The drug of choice for secondary syphilis is a single IM dose of **Benzathine Penicillin G (2.4 million units)**.
Question 80: Which of the following is NOT a characteristic of secondary syphilis?
- A. It may be asymptomatic.
- B. It usually involves palms and soles.
- C. It presents with vesicular bullous lesions. (Correct Answer)
- D. Lymphadenopathy is common.
Explanation: Secondary syphilis is the systemic stage of infection caused by *Treponema pallidum*, occurring 4–10 weeks after the primary chancre. [1] ### **Why Option C is the Correct Answer** Syphilis is famously known as the **"Great Mimicker"** because it can present with almost any type of rash (macular, papular, or pustular) [1]. However, a key diagnostic rule in adult syphilis is that **it never presents with vesicular or bullous (blistering) lesions.** If a patient presents with a generalized blistering rash, syphilis can be clinically ruled out. * *Exception:* Vesiculobullous lesions are only seen in **Congenital Syphilis** (Pemphigus syphiliticus). ### **Analysis of Incorrect Options** * **A. It may be asymptomatic:** While secondary syphilis typically presents with a rash, some patients may have a "latent" transition where clinical signs are minimal or resolve spontaneously while the serology remains positive [1]. * **B. It usually involves palms and soles:** This is a high-yield clinical hallmark. A copper-red, maculopapular rash involving the palms and soles is highly suggestive of secondary syphilis [1]. * **D. Lymphadenopathy is common:** Generalized, painless, non-suppurative lymphadenopathy (especially epitrochlear nodes) is a classic feature of this stage [1]. ### **NEET-PG High-Yield Pearls** * **Condyloma Lata:** Highly infectious, moist, flat-topped papules found in intertriginous areas (e.g., axilla, perineum) [1]. * **Lues Maligna:** A rare, severe form of secondary syphilis with pleomorphic, necrotic ulcers seen in immunocompromised (HIV) patients. * **Snail Track Ulcers:** Mucous patches in the oropharynx. * **Diagnosis:** Screening is done via **VDRL/RPR** (non-specific); confirmation requires **FTA-ABS/TPHA** (specific).
Practice by Chapter
Syphilis
Practice Questions
Gonorrhea
Practice Questions
Chlamydial Infections
Practice Questions
Chancroid and Other Genital Ulcers
Practice Questions
Genital Herpes
Practice Questions
Human Papillomavirus Infections
Practice Questions
HIV and STIs
Practice Questions
Pelvic Inflammatory Disease
Practice Questions
STI Screening and Prevention
Practice Questions
Partner Notification and Treatment
Practice Questions
Sexually Transmitted Enteric Infections
Practice Questions
Special Populations Management
Practice Questions
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