Venerology Practice Questions

Q: What is the characteristic of a primary chancre?

Painless punched out ulcer. The primary chancre is the hallmark lesion of **Primary Syphilis**, caused by the spirochete *Treponema pallidum*. **1. Why Option A is Correct:** A primary chancre typically appears 3 weeks after exposure. Its classic description is a **painless, indurated (firm), and "punched-out" ulcer** with a clean base. The lack of pain is due to the absence of an acute inflammatory response, and the "punched-out" appearance refers to its well-defined, regular margins [1]. **2. Analysis of Incorrect Options:** * **Option B (Overhanging edges):** This is characteristic of **Chancroid** (*Haemophilus ducreyi*). Unlike syphilis, chancroid presents with multiple, very painful ulcers with undermined or overhanging edges. * **Option C (Irregular raised edges):** This description is more suggestive of **Granuloma Inguinale (Donovanosis)** or potentially a malignant ulcer. Donovanosis presents as beefy-red, painless, expanding ulcers with exuberant granulation tissue. * **Option D (Painful punched out ulcer):** While the shape is correct, the presence of pain excludes a typical syphilitic chancre [1]. Painful ulcers are usually associated with **Herpes Simplex Virus (HSV)** or **Chancroid** [2]. **Clinical Pearls for NEET-PG:** * **Induration:** The base of a syphilitic chancre feels like a "button" or "cartilage" when palpated (Hunterian Chancre). * **Lymphadenopathy:** Primary syphilis is associated with **painless, non-suppurative, rubbery** bilateral inguinal lymphadenopathy. * **Diagnosis:** The gold standard for primary syphilis is **Dark Ground Microscopy (DGM)** to visualize motile spirochetes. Serological tests (VDRL/RPR) may be negative in the first 1–2 weeks of the chancre's appearance. * **Treatment:** The drug of choice is **Benzathine Penicillin G** (2.4 million units IM, single dose).

Q: Rectal stricture is a common manifestation of which of the following conditions?

Lymphogranuloma inguinale. **Explanation:** **Lymphogranuloma inguinale** (also known as **Lymphogranuloma Venereum or LGV**) is caused by *Chlamydia trachomatis* serotypes L1, L2, and L3. The correct answer is B because rectal stricture is a classic late-stage complication of the **genito-anorectal syndrome** seen in LGV. In women and MSM (men who have sex with men), the infection can spread via lymphatic drainage to the perirectal and pelvic lymph nodes. This leads to chronic inflammation, proctocolitis, and lymphatic obstruction. Over time, the resulting fibrosis and scarring lead to the formation of **rectal strictures**, fistulae, and "esthiomene" (chronic hypertrophic ulceration of the external genitalia). **Analysis of Incorrect Options:** * **A. Syphilis:** Caused by *Treponema pallidum*. While it can cause proctitis in the secondary stage, it typically presents with a painless chancre (primary) or a generalized rash; it does not typically lead to fibrotic rectal strictures. * **C. Granuloma inguinale (Donovanosis):** Caused by *Klebsiella granulomatis*. It presents with painless, beefy-red, highly vascular ulcers (pseudobuboes). It involves the skin and subcutaneous tissues rather than deep pelvic lymphatics. * **D. Chancroid:** Caused by *Haemophilus ducreyi*. It presents with painful, soft ulcers and painful inguinal lymphadenopathy (suppurative buboes), but it does not cause chronic rectal fibrosis. **NEET-PG High-Yield Pearls:** * **Groove Sign of Greenblatt:** Pathognomonic for LGV; it is the depression between inflamed inguinal and femoral lymph nodes separated by the inguinal ligament. * **Donovan Bodies:** Safety-pin appearance in macrophages, diagnostic for Granuloma inguinale. * **School of Fish appearance:** Characteristic Gram stain finding for Chancroid. * **Frei Test:** A historical skin test used for LGV diagnosis (now replaced by NAAT).

Q: What condition typically presents with multiple painful bleeding ulcers and inguinal bubo?

Chancroid. ### Explanation **Chancroid** is caused by the Gram-negative coccobacillus *Haemophilus ducreyi*. It is classically characterized by the "Four Ps": **P**ainful, **P**urulent, **P**olymicrobial (multiple), and **P**unch-out ulcers. These ulcers are soft and bleed easily upon manipulation (friable). A hallmark feature is the development of a painful, unilateral **inguinal bubo** (suppurative lymphadenopathy) which may rupture spontaneously [1]. **Analysis of Incorrect Options:** * **Chancre (Syphilis):** Caused by *Treponema pallidum*. It typically presents as a **painless**, single, indurated (hard) ulcer with clean base and painless lymphadenopathy. * **Granuloma Inguinale (Donovanosis):** Caused by *Klebsiella granulomatis*. It presents as chronic, **painless**, beefy-red velvety ulcers that bleed on touch [1]. There is no true lymphadenopathy; instead, it causes "pseudobuboes" (granulomatous nodules). * **Lymphogranuloma Venereum (LGV):** Caused by *Chlamydia trachomatis* (L1-L3). The initial ulcer is small, **painless**, and transient (often missed) [1]. It is followed by painful inguinal lymphadenopathy with the characteristic "Groove sign." **Clinical Pearls for NEET-PG:** * **School of Fish Appearance:** Classic Gram stain finding for *H. ducreyi*. * **Railroad Track Appearance:** Another description for the parallel arrangement of *H. ducreyi*. * **Treatment of Choice:** Azithromycin (1g orally, single dose) or Ceftriaxone. * **Differential Tip:** If the ulcer is **P**ainful, think **H**erpes or **H**aemophilus (**P**ainful **H**oles). If **P**ainless, think Syphilis or Donovanosis.

Q: A painful vaginal ulcer with inguinal lymphadenopathy and a "school of fish" appearance on microscopy are characteristic of which sexually transmitted infection?

Chancroid. ### Explanation **Correct Answer: D. Chancroid** **Why it is correct:** Chancroid is caused by the Gram-negative coccobacillus ***Haemophilus ducreyi*** [1]. It is characterized by the clinical triad of **painful** genital ulcers (often multiple with ragged edges), inflammatory **inguinal lymphadenopathy** (buboes), and a specific microscopic arrangement [1]. On Gram stain, the organisms align in parallel rows, described classically as a **"school of fish"** or "railroad track" appearance. **Why the other options are incorrect:** * **Syphilis (Treponema pallidum):** Presents with a **painless**, indurated ulcer (chancre) [1]. Microscopy via dark-field illumination shows corkscrew-shaped motile spirochetes, not a school of fish pattern. * **Lymphogranuloma venereum (LGV):** Caused by *Chlamydia trachomatis* (L1-L3). It features a transient, **painless** papule/ulcer followed by painful "Groove sign" lymphadenopathy [1]. It is an obligate intracellular organism. * **Granuloma inguinale (Donovanosis):** Caused by *Klebsiella granulomatis*. It presents as **painless**, beefy-red velvety ulcers that bleed on touch [1]. Microscopy reveals **Donovan bodies** (safety-pin appearance) within macrophages. **High-Yield Clinical Pearls for NEET-PG:** * **Painful vs. Painless:** Remember **"H. ducreyi makes you cry"** (Painful = Chancroid and Herpes; Painless = Syphilis, LGV, and Donovanosis). * **Buboes:** In Chancroid, lymphadenopathy is painful and may suppurate (unilateral). * **Treatment:** A single dose of **Azithromycin (1g)** or Ceftriaxone (250mg IM) is the first-line management. * **Culture:** Requires special media (e.g., Mueller-Hinton agar with vancomycin) and is difficult to grow.

Q: Lymphogranuloma venerum is characterized by all of the following except?

Metronidazole is an effective treatment.. **Lymphogranuloma Venereum (LGV)** is a sexually transmitted infection caused by **Chlamydia trachomatis serovars L1, L2, and L3**. ### Explanation of Options: * **Option C (Correct Answer):** Metronidazole is an antiprotozoal and anaerobic antibacterial agent; it has no activity against *Chlamydia*. The **first-line treatment for LGV is Doxycycline** (100 mg twice daily for 21 days). Erythromycin or Azithromycin are alternatives. * **Option A:** The primary lesion is typically a small, painless papule or ulcer that is transient and often goes unnoticed. It **heals rapidly without leaving a scar**, which distinguishes it from the scarring seen in Syphilis or Chancroid. * **Option B:** LGV is a systemic disease. Beyond local lesions, patients frequently present with **systemic symptoms** such as fever, chills, malaise, and myalgia, especially during the secondary stage (lymphatic spread) [1]. * **Option C:** The **"Groove Sign" (Greenblatt’s sign)** is a pathognomonic clinical finding. It occurs when the inguinal ligament divides matted, enlarged inguinal and femoral lymph nodes, creating a visible depression or "groove" between the two groups of nodes [1]. ### NEET-PG High-Yield Pearls: * **Stages:** 1° (Primary ulcer) → 2° (Inguinal syndrome/Buboes) → 3° (Anogenital syndrome/Strictures). * **Esthiomene:** A chronic complication involving hypertrophic ulceration and elephantiasis of the female external genitalia due to lymphatic obstruction. * **Diagnosis:** Nucleic Acid Amplification Test (NAAT) is the preferred diagnostic method. Frei’s test is a historical skin test (now obsolete). * **Proctocolitis:** Common in MSM (Men who have sex with men), presenting with rectal discharge, pain, and tenesmus [1].

Q: Du Bois sign seen in syphilis is:

Shortening of the little finger. **Explanation:** **Du Bois Sign** is a classic clinical sign associated with **Congenital Syphilis**. It refers to the **shortening of the little finger** (pinky finger) due to the premature separation or destruction of the epiphysis of the fifth metacarpal bone. This occurs as a result of syphilitic osteochondritis, a common skeletal manifestation in infants born with the infection. **Analysis of Options:** * **Option A (Correct):** Shortening of the little finger is the definitive definition of Du Bois sign. It is a high-yield morphological marker for late congenital syphilis. * **Option B (Incorrect):** Small patches on the back do not correspond to any named sign in syphilis. While secondary syphilis presents with a generalized maculopapular rash, it is not referred to as Du Bois sign. * **Option C (Incorrect):** Tightening of the fingers (sclerodactyly) is characteristic of systemic sclerosis (Scleroderma), not syphilis. **High-Yield Clinical Pearls for NEET-PG:** To master Congenital Syphilis, remember the **Hutchinson’s Triad**: 1. **Hutchinson’s teeth** (notched incisors). 2. **Interstitial keratitis** (leading to blindness). 3. **Eighth nerve deafness** (sensorineural hearing loss). **Other Skeletal Signs in Syphilis:** * **Higoumenakis sign:** Unilateral thickening of the inner third of the clavicle. * **Wimberger’s sign:** Focal erosion of the medial aspect of the proximal tibial metaphysis. * **Saber Shin:** Anterior bowing of the tibia due to periostitis. * **Clutton’s joints:** Symmetrical painless swelling of the knees.

Q: Genito-ulcerative (non-herpetic) diseases are coded under which color in the Standard Treatment Guidelines (STG) kits?

White. ### Explanation The National AIDS Control Organization (NACO) in India utilizes a **Syndromic Management** approach for Sexually Transmitted Infections (STIs). This method uses color-coded kits to provide immediate, standardized treatment based on clinical presentation rather than waiting for laboratory confirmation. **1. Why White is Correct:** The **White Kit** is specifically designed for **Genital Ulcerative Disease (Non-Herpetic)**. It is used when a patient presents with a non-vesicular ulcer [1]. * **Contents:** Injection Benzathine Penicillin (2.4 million units) and Tablet Azithromycin (1g). **2. Analysis of Incorrect Options:** * **Grey (Option A):** Used for **Urethral Discharge, Cervical Discharge, and Anorectal Discharge**. It contains Azithromycin (1g) and Cefixime (400mg). * **Blue (Option B):** Used for **Vaginal Discharge** (Bacterial Vaginosis and Trichomoniasis). It contains Metronidazole (2g) and Secnidazole (2g) or Clindamycin. * **Red (Option D):** Used for **Genital Ulcerative Disease (Herpetic)**. It contains Acyclovir (400mg) to treat Herpes Simplex Virus (HSV-2) [1]. **3. Clinical Pearls for NEET-PG:** * **Green Kit:** Used for **Vaginal Discharge** (specifically Candidiasis). Contains Fluconazole (150mg) [1]. * **Yellow Kit:** Used for **Lower Abdominal Pain** (Pelvic Inflammatory Disease). * **Black Kit:** Used for **Inguinal Bubo**. Contains Azithromycin and Doxycycline. * **High-Yield Tip:** If a genital ulcer is painful and soft, think **Chancroid** (*H. ducreyi*); if painless and hard, think **Syphilis** (*T. pallidum*). Both are covered by the **White Kit**.

Q: A young long-distance lorry driver presents with a painless penile ulcer 9 days after sexual intercourse with a professional sex worker. What is the likely diagnosis?

Chancre. The clinical presentation points toward **Primary Syphilis**, characterized by the **Chancre**. [1] ### 1. Why Chancre is the Correct Answer The diagnosis is based on three classic features described in the stem: * **Painless nature:** The hallmark of a syphilitic chancre is that it is typically painless, indurated (hard), and clean-based. * **Incubation Period:** The ulcer appeared 9 days after exposure. The incubation period for *Treponema pallidum* is typically 9–90 days (average 3 weeks), making 9 days a perfect fit. * **Risk Factors:** Long-distance lorry drivers are a classic high-risk group mentioned in NEET-PG vignettes for Sexually Transmitted Infections (STIs). ### 2. Why Other Options are Incorrect * **Herpes Genitalis:** Caused by HSV-2, these ulcers are characteristically **multiple, superficial, and very painful**. [1] They are preceded by vesicles. * **Chancroid:** Caused by *Haemophilus ducreyi*, these ulcers are **painful** ("Soft Chancre") with ragged edges and a necrotic base. * **Traumatic Ulcer:** These usually have an immediate onset following trauma and lack the specific induration of a chancre. ### 3. Clinical Pearls for NEET-PG * **Investigation of Choice:** The gold standard for a primary chancre is **Dark Ground Microscopy (DGM)** to visualize spirochetes. Serology (VDRL/RPR) may be negative in the first 1–2 weeks of the ulcer. * **Lymphadenopathy:** Syphilis presents with **painless, rubbery, non-suppurative** regional lymphadenopathy. In contrast, Chancroid presents with painful, suppurative "buboes." * **Treatment:** The drug of choice is **Benzathine Penicillin G** (2.4 million units IM single dose).

Question 1

What is the characteristic of a primary chancre?

Accepted Answer

Painless punched out ulcer

Answer

Painless ulcer with overhanging edges

Answer

Painless ulcer with irregular raised edges

Answer

Painful punched out ulcer

Question 2

Rectal stricture is a common manifestation of which of the following conditions?

Accepted Answer

Lymphogranuloma inguinale

Answer

Syphilis

Answer

Granuloma inguinale

Answer

Chancroid

Question 3

What condition typically presents with multiple painful bleeding ulcers and inguinal bubo?

Accepted Answer

Chancroid

Answer

Chancre

Answer

Granuloma inguinale

Answer

Lymphogranuloma Venereum

Question 4

What is the recommended dose of benzathine penicillin for early syphilis?

Accepted Answer

2.4 million units intramuscularly as a single injection

Answer

3-4 million units intravenously

Answer

2.4 million units intramuscularly daily, plus probenecid 500 mg orally for 14 days

Answer

2.4 million units intramuscularly weekly for three doses

Question 5

A painful vaginal ulcer with inguinal lymphadenopathy and a "school of fish" appearance on microscopy are characteristic of which sexually transmitted infection?

Accepted Answer

Chancroid

Answer

Syphilis

Answer

Lymphogranuloma venereum (LGV)

Answer

Granuloma inguinale (Donovanosis)

Question 6

Lymphogranuloma venerum is characterized by all of the following except?

Accepted Answer

Metronidazole is an effective treatment.

Answer

Primary lesions heal without scarring.

Answer

Commonly develop systemic infection.

Answer

Groove sign is seen characteristically.

Question 7

A patient presenting with vaginal discharge, whose husband is a long-haul truck driver, attends a sexually transmitted disease clinic. What is the recommended empirical treatment?

Accepted Answer

Azithromycin + metronidazole + fluconazole

Answer

Azithromycin

Answer

Metronidazole + fluconazole

Answer

Fluconazole

Question 8

Du Bois sign seen in syphilis is:

Accepted Answer

Shortening of the little finger

Answer

Small patches are seen on the back

Answer

Tightening of the fingers

Answer

All of the above

Question 9

Genito-ulcerative (non-herpetic) diseases are coded under which color in the Standard Treatment Guidelines (STG) kits?

Accepted Answer

White

Answer

Grey

Answer

Blue

Answer

Red

Question 10

A young long-distance lorry driver presents with a painless penile ulcer 9 days after sexual intercourse with a professional sex worker. What is the likely diagnosis?

Accepted Answer

Chancre

Answer

Herpes Genitalis

Answer

Chancroid

Answer

Traumatic ulcer

Venerology — MCQs

Venerology — MCQs

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