Venerology Practice Questions

Q: The oral lesion of syphilis that is highly infective is a:

Mucous patch. **Explanation:** The correct answer is **Mucous patch**. Syphilis, caused by the spirochete *Treponema pallidum*, progresses through distinct clinical stages. 1. **Why Mucous Patch is correct:** Mucous patches are a hallmark of **Secondary Syphilis** [1]. They appear as painless, shallow, grayish-white ulcerations on the oral mucosa, tongue, or tonsils. These lesions contain an extremely high concentration of spirochetes, making them **highly infectious** through direct contact or saliva. Along with *Condyloma lata*, they represent the peak of infectivity during the secondary stage [1]. 2. **Analysis of Incorrect Options:** * **Gumma (Option A):** These are granulomatous lesions characteristic of **Tertiary Syphilis**. While destructive to local tissue (e.g., perforation of the hard palate), they contain very few spirochetes and are considered **non-infectious**. [1] * **Koplik spot (Option B):** These are pathognomonic for **Measles (Rubeola)**, not syphilis. They appear as small white spots on a buccal mucosal background of erythema, typically opposite the lower second molars. * **Tabes dorsalis (Option C):** This is a clinical form of **Neurosyphilis** (Tertiary stage) involving the degeneration of the posterior columns of the spinal cord. It is a neurological manifestation, not an oral lesion. [1] **High-Yield Clinical Pearls for NEET-PG:** * **Primary Syphilis:** Characterized by the **Chancre** (painless, indurated ulcer). [1] * **Secondary Syphilis:** Known as "The Great Imitator." Features include a generalized maculopapular rash (involving palms/soles), generalized lymphadenopathy, and **Snail-track ulcers** (another name for coalesced mucous patches). [1] * **Infectivity:** The most infectious stages are Primary and Secondary. * **Drug of Choice:** Parenteral **Benzathine Penicillin G** remains the gold standard for all stages.

Q: Syphilitic gumma is seen in which stage of syphilis?

Tertiary Syphilis. **Explanation:** Syphilis, caused by the spirochete *Treponema pallidum*, progresses through distinct clinical stages if left untreated. The **Syphilitic Gumma** is the hallmark lesion of **Tertiary Syphilis** (Late Syphilis) [1]. **Why Tertiary Syphilis is correct:** Tertiary syphilis occurs years (3–15+) after the initial infection. A gumma is a chronic, granulomatous lesion characterized by a center of coagulative necrosis surrounded by lymphocytes, plasma cells, and epithelioid cells [1]. These lesions are non-infectious and represent a delayed-type hypersensitivity reaction to the spirochetes. They commonly affect the skin, bones, and liver (hepar lobatum). **Why other options are incorrect:** * **Primary Syphilis:** Characterized by the **Chancre**—a solitary, painless, indurated ulcer at the site of inoculation, usually accompanied by regional lymphadenopathy [1]. * **Secondary Syphilis:** Known as the "Great Imitator," it presents with systemic features like generalized lymphadenopathy, **condyloma lata**, and a maculopapular rash involving the palms and soles [1]. * **Quaternary Syphilis:** This is an obsolete term sometimes historically used to describe neurosyphilis; however, in modern medical classification, neurosyphilis and cardiovascular syphilis are categorized under Tertiary Syphilis [1]. **High-Yield Clinical Pearls for NEET-PG:** * **Gumma Location:** Most common site is the skin and skeletal system; the **palate** and **nasal septum** are frequently involved, leading to perforation. * **Argyll Robertson Pupil:** "The Prostitute's Pupil" (accommodates but does not react to light) is a classic finding in Tertiary Syphilis (Tabes Dorsalis). * **Screening vs. Confirmatory:** VDRL/RPR are non-specific screening tests; **FTA-ABS** and **TPHA** are specific treponemal tests used for confirmation. * **Treatment:** Benzathine Penicillin G remains the drug of choice for all stages.

Q: Which of the following is characteristic of Granuloma inguinale?

Beefy red ulcers that bleed easily. **Granuloma Inguinale (Donovanosis)** is a chronic, progressive bacterial infection caused by the Gram-negative intracellular bacterium ***Klebsiella granulomatis*** (formerly *Calymmatobacterium granulomatis*). ### **Explanation of Options** * **Correct Answer (B):** The hallmark of Donovanosis is the presence of **beefy red, velvety, painless ulcers**. These lesions are highly vascular due to extensive granulation tissue, which causes them to **bleed easily on contact**. Despite the extensive tissue destruction, the ulcers remain painless unless secondarily infected. * **Option A:** *Gardnerella vaginalis* is the causative agent of Bacterial Vaginosis (associated with Clue cells and a fishy odor), not Granuloma inguinale. * **Option C:** Painful inflammatory nodules are characteristic of **Chancroid** (*Haemophilus ducreyi*) or **Lymphogranuloma Venereum (LGV)** during the bubo stage. Donovanosis typically presents with "pseudobuboes"—firm, painless swellings in the groin that are actually subcutaneous granulomas rather than true lymphadenopathy. * **Option D:** Donovanosis has a relatively **long and variable incubation period**, typically ranging from **1 to 12 weeks** (average 50 days). A short incubation period of 1–3 days is more characteristic of Chancroid. ### **High-Yield Clinical Pearls for NEET-PG** * **Pathognomonic Sign:** **Donovan Bodies** (safety-pin appearance) seen within large mononuclear cells (macrophages) on Giemsa or Wright stain. * **Clinical Presentation:** Painless, beefy red ulcers; **absence of true inguinal lymphadenopathy** (Pseudobuboes). * **Treatment of Choice:** **Azithromycin** (1g orally once weekly or 500mg daily) for at least 3 weeks or until lesions have completely healed. * **Differential Diagnosis:** Must be distinguished from Syphilis (painless but clean-based ulcer) and Chancroid (painful, dirty-based ulcer).

Q: A 30-year-old man had sexual exposure to a commercial sex worker and develops a painless indurated ulcer on the glans after 3 weeks. What is the diagnosis?

Syphilis. The clinical presentation of a **painless, indurated ulcer** following an incubation period of approximately 3 weeks (range 9–90 days) is the classic hallmark of **Primary Syphilis**, caused by *Treponema pallidum*. The lesion, known as a **Chancre**, typically presents as a solitary, clean-based ulcer with "cartilage-like" induration and is often accompanied by painless, non-suppurative regional lymphadenopathy. **Why other options are incorrect:** * **Chancroid (Haemophilus ducreyi):** Presents as a **painful**, soft ulcer with a ragged, undermined edge and a necrotic base. It is often associated with painful, suppurative inguinal lymphadenitis (buboes). * **Herpes Simplex Virus (HSV):** Typically presents as multiple, small, **painful vesicles** that rupture to form shallow, non-indurated erosions [1]. It has a much shorter incubation period (2–7 days) [1]. * **Traumatic Ulcer:** These occur immediately after the injury, lack induration, and usually have a history of clear mechanical or chemical trauma. **High-Yield Clinical Pearls for NEET-PG:** * **Incubation Period:** Syphilis (3 weeks) vs. Chancroid (3–7 days) vs. HSV (2–7 days). * **Diagnosis:** The gold standard for primary syphilis is **Dark Ground Microscopy (DGM)** to visualize spirochetes. Serological tests (VDRL/RPR) may be negative in the first 1–2 weeks of the chancre [1]. * **Treatment:** The drug of choice for primary syphilis is **Benzathine Penicillin G** (2.4 million units IM, single dose). * **Key Distinction:** Remember the mnemonic: **"Syphilis is Silently (Painless) Hard (Indurated), Chancroid is a Soft (Non-indurated) Sore (Painful)."**

Q: Which of the following conditions is typically associated with cancerous involvement?

Syphilitic glossitis. **Explanation:** The correct answer is **Syphilitic glossitis**. This condition, specifically **chronic superficial glossitis** (also known as "leukoplakia of the tongue"), occurs during the tertiary stage of syphilis. It is considered a **premalignant condition**. Chronic inflammation and endarteritis lead to atrophy of the lingual papillae and the development of white patches (leukoplakia), which carry a significant risk of transforming into **Squamous Cell Carcinoma (SCC)** of the tongue. **Analysis of Incorrect Options:** * **Chancre (Option A):** This is the hallmark of **Primary Syphilis**. It is a painless, indurated ulcer that heals spontaneously without scarring. It is an infectious lesion, not a premalignant one. * **Mucous Patch (Option B):** Seen in **Secondary Syphilis**, these are highly infectious, shallow, greyish-white ulcers on the oral mucosa. They resolve with treatment and do not lead to malignancy. * **Gumma (Option C):** A characteristic of **Tertiary Syphilis**, a gumma is a localized area of granulomatous inflammation and coagulative necrosis. While destructive to local tissues (like the hard palate), it is not typically associated with cancerous transformation. **High-Yield Clinical Pearls for NEET-PG:** * **Syphilis and Cancer:** Among all syphilitic lesions, chronic interstitial glossitis is the only one with a strong association with oral malignancy. * **The "Great Imitator":** Syphilis is caused by *Treponema pallidum*. * **Tertiary Syphilis Triad:** Gummas, Cardiovascular syphilis (Aortitis), and Neurosyphilis (Tabes dorsalis). * **Hutchinson’s Triad (Congenital Syphilis):** Interstitial keratitis, sensorineural hearing loss, and Hutchinson’s teeth (notched incisors).

Q: A false positive Fluorescent Treponemal Antibody Absorption (FTA-ABS) test is seen in which of the following conditions?

Lyme disease. The **FTA-ABS (Fluorescent Treponemal Antibody Absorption)** test is a treponemal-specific test used to confirm syphilis. It detects antibodies against *Treponema pallidum*. However, false positives occur due to **cross-reactivity** with other spirochetes. **Why Lyme Disease is correct:** Lyme disease is caused by ***Borrelia burgdorferi***, which is a spirochete closely related to *Treponema pallidum*. Because they share similar surface antigens, antibodies produced against *Borrelia* can cross-react with the antigens used in the FTA-ABS test, leading to a false-positive result. **Analysis of Incorrect Options:** * **Systemic Lupus Erythematosus (SLE):** SLE is a classic cause of false positives in **non-treponemal tests** (VDRL/RPR) due to the presence of anti-cardiolipin antibodies [1]. It typically does *not* cause a false positive in specific treponemal tests like FTA-ABS. * **Infectious Mononucleosis & HIV:** These viral infections are well-known causes of biological false positives (BFP) in **VDRL/RPR** tests [1] (due to transient tissue damage and lipid release), but they rarely affect the specificity of the FTA-ABS. **High-Yield Clinical Pearls for NEET-PG:** * **VDRL False Positives (Mnemonic: PAREVE):** **P**regnancy, **A**cute infection (Malaria, Mono), **R**heumatoid Arthritis, **E**nteric fever, **V**iral (HIV, Hepatitis), **E**rythematosus (SLE). * **FTA-ABS False Positives:** Primarily seen in other spirochetal infections (Lyme disease, Yaws, Pinta, Bejel) and occasionally in Lepromatous Leprosy. * **Sequence of Testing:** Screening is done with VDRL/RPR (high sensitivity); confirmation is done with FTA-ABS or TPHA (high specificity). * **Persistence:** Unlike VDRL, which becomes negative after treatment, the FTA-ABS remains positive for life ("Treponemal memory").

Q: Which of the following conditions is not caused by Chlamydia trachomatis?

Vulvitis. The correct answer is **Vulvitis**. *Chlamydia trachomatis* (Serotypes D-K) is an obligate intracellular bacterium that specifically targets **columnar or transitional epithelium**. The vulva is covered by **stratified squamous epithelium**, which is resistant to chlamydial infection. Therefore, *C. trachomatis* does not cause primary vulvitis. **Analysis of Options:** * **Cervicitis (Option A):** Chlamydia is the most common cause of bacterial cervicitis. It infects the columnar epithelium of the endocervix, often presenting with mucopurulent discharge and friability. * **Urethritis (Option B):** It is the leading cause of Non-Gonococcal Urethritis (NGU) in men [1]. It infects the transitional epithelium of the urethra. * **Epididymitis (Option D):** In men under 35 years of age, *C. trachomatis* is the most common cause of acute epididymitis via ascending infection from the urethra [1]. **Clinical Pearls for NEET-PG:** 1. **Tissue Tropism:** Remember that Chlamydia "hates" squamous cells but "loves" columnar cells. This explains why it causes cervicitis (endocervix) but not vaginitis or vulvitis (squamous). 2. **Serotypes:** * **A, B, Ba, C:** Trachoma (leading cause of preventable blindness). * **D-K:** Genital infections (Urethritis, PID, Neonatal conjunctivitis/pneumonia). * **L1, L2, L3:** Lymphogranuloma Venereum (LGV) characterized by the "Groove sign." 3. **Treatment:** The drug of choice is **Doxycycline** (100 mg BID for 7 days). Azithromycin (1g stat) is an alternative, especially in pregnancy. 4. **Co-infection:** Always screen for *Neisseria gonorrhoeae* when Chlamydia is suspected [1].

Question 1

The oral lesion of syphilis that is highly infective is a:

Accepted Answer

Mucous patch

Answer

Gumma

Answer

Koplik spot

Answer

Tabes dorsalis

Question 2

Syphilitic gumma is seen in which stage of syphilis?

Accepted Answer

Tertiary Syphilis

Answer

Primary Syphilis

Answer

Secondary Syphilis

Answer

Quaternary Syphilis

Question 3

Which of the following is characteristic of Granuloma inguinale?

Accepted Answer

Beefy red ulcers that bleed easily

Answer

Is caused by Gardnerella vaginalis

Answer

Painful inflammatory nodules

Answer

Short incubation period of 3 days

Question 4

A young man presents with asymptomatic macules and erythematous painless lesions over the glans with generalized lymphadenopathy. What is the treatment of choice in this condition?

Accepted Answer

Benzathine penicillin

Answer

Ceftriaxone

Answer

Acyclovir

Answer

Fluconazole

Question 5

A 30-year-old man had sexual exposure to a commercial sex worker and develops a painless indurated ulcer on the glans after 3 weeks. What is the diagnosis?

Accepted Answer

Syphilis

Answer

Chancroid

Answer

Herpes Simplex Virus (HSV)

Answer

Traumatic

Question 6

Which of the following conditions is typically associated with cancerous involvement?

Accepted Answer

Syphilitic glossitis

Answer

Chancre

Answer

Mucous patch

Answer

Gumma

Question 7

A false positive Fluorescent Treponemal Antibody Absorption (FTA-ABS) test is seen in which of the following conditions?

Accepted Answer

Lyme disease

Answer

Human Immunodeficiency Virus (HIV) infection

Answer

Infectious mononucleosis

Answer

Systemic Lupus Erythematosus (SLE)

Question 8

What is the drug of choice and its dosage for primary syphilis?

Accepted Answer

Benzathine penicillin 2.4 million units deep IM

Answer

Amoxicillin 500 mg for 5 days

Answer

Erythromycin 2 gm daily for 2 weeks

Answer

Doxycycline 100 mg daily for 2 weeks

Question 9

Which of the following conditions is not caused by Chlamydia trachomatis?

Accepted Answer

Vulvitis

Answer

Cervicitis

Answer

Urethritis

Answer

Epididymitis

Question 10

Which is the most frequent cause of recurrent genital ulceration in a sexually active male?

Accepted Answer

Herpes genitalis

Answer

Syphilis

Answer

Chancroid

Answer

Aphthous ulcer

Venerology — MCQs

Venerology — MCQs

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