Venerology Practice Questions

Q: A 45-year-old man with a history of multiple sexual partners presents with a non-tender genital ulcer and a generalized rash. Which stage of syphilis is he likely in?

Secondary syphilis. ***Secondary syphilis*** - The coexistence of a **non-tender genital ulcer** (chancre from primary syphilis) and a **generalized rash** is a classic presentation of secondary syphilis [1]. - This stage occurs weeks to months after the primary infection, as the spirochetes disseminate throughout the body. *Primary syphilis* - Characterized by a **single, painless chancre** at the site of infection and typically **lacks systemic symptoms** like a rash [1]. - The man's presentation includes a generalized rash, which is not characteristic of primary syphilis alone. *Latent syphilis* - This stage is typically **asymptomatic**, meaning there are no visible signs or symptoms, though serological tests remain positive [1]. - The presence of both a genital ulcer and a rash indicates active disease, not latent syphilis. *Tertiary syphilis* - Occurs years to decades after the initial infection and presents with severe complications affecting the **heart, brain, or other organs** (e.g., gummas, neurosyphilis, cardiovascular syphilis) [1]. - The patient's symptoms of a genital ulcer and rash are acute manifestations, not the chronic, destructive lesions of tertiary syphilis.

Q: In a patient presenting with inguinal lymphadenopathy, which condition is associated with the Groove sign of Greenbalt?

Lymphogranuloma venereum (LGV). ***Lymphogranuloma venereum (LGV)*** - The **Groove sign of Greenblatt** is a characteristic clinical finding in LGV, where enlarged inguinal lymph nodes (buboes) are separated by the **inguinal ligament**, creating a visible groove [1]. - LGV is caused by specific serovars of *Chlamydia trachomatis* and initially presents with a painless ulcer, followed by painful lymphadenopathy and **bubo formation** [1]. *Chancroid (Haemophilus ducreyi)* - Chancroid typically presents with **painful genital ulcers** and painful, often **unilateral inguinal lymphadenopathy** (buboes), which may suppurate [1]. - While it causes inguinal lymphadenopathy, it is not associated with the specific **Groove sign of Greenblatt**. *Genital Herpes (Herpes Simplex Virus)* - Genital herpes is characterized by **painful vesicular or ulcerative lesions** on the genitalia, often accompanied by local symptoms like itching and burning [1]. - While it can cause **tender inguinal lymphadenopathy** due to localized inflammation, the lymph node swelling is typically generalized and does not form a distinct Groove sign [1]. *Granuloma inguinale (Donovanosis)* - This condition is characterized by **progressive, beefy-red granulomatous lesions** that are typically painless and bleed easily, primarily affecting the genitals and perineum [1]. - **Inguinal lymphadenopathy is rare**; if present, it is usually due to secondary bacterial infection or pseudobuboes, not true lymphatic involvement or the Groove sign [1].

Q: In the context of sexually transmitted infections, which condition is characterized by the presence of pseudobubo?

Lymphogranuloma inguinale. ***Lymphogranuloma inguinale*** - This condition is caused by specific serovars of **Chlamydia trachomatis** and is characterized by the formation of **pseudobuboes** (inflamed inguinal lymph nodes) [1]. - Pseudobuboes in LGV are typically **large, tender, matted lymph nodes** that may rupture and drain, forming multiple sinus tracts [1]. *Chancroid* - Chancroid is characterized by **painful genital ulcers with ragged borders** and often results in **suppurative inguinal lymphadenitis** [1]. - While it causes significant lymphadenopathy, the term **pseudobubo** is specifically associated with Lymphogranuloma Venereum due to the characteristic pattern of matted, inflamed nodes. *Syphilis* - Syphilis presents with a **painless chancre** in its primary stage and can cause **bilateral, nontender regional lymphadenopathy**. - The lymph nodes associated with primary syphilis are not typically inflamed or suppurative, and they do not form pseudobuboes. *Herpes simplex* - Herpes simplex virus causes **painful vesicular or ulcerative lesions** on the genitals, often accompanied by **tender, often bilateral, inguinal lymphadenopathy**. - The lymphadenopathy in herpes is usually less severe and does not typically progress to the large, matted, and potentially suppurative pseudobuboes seen in LGV.

Q: Patient presents with discharge per urethrum and microscopy shows presence of intracytoplasmic gram negative cocci; what is the most probable diagnosis ?

Gonococcal infection. ***Gonococcal infection*** - The presence of **intracytoplasmic gram-negative cocci** in urethral discharge is a classic microscopic finding for **Neisseria gonorrhoeae**. [1] - This presentation is highly indicative of **gonorrhea**, a sexually transmitted infection. [1] *Granuloma inguinale* - This condition, also known as **donovanosis**, is caused by **Klebsiella granulomatis**. [1] - It typically presents with **granulomatous ulcers** and is diagnosed by finding **Donovan bodies** (bacteria within macrophages) in tissue smears, not free cocci in urethral discharge. [1] *Vaginal bacterial infection* - This term is too general; however, most common vaginal bacterial infections (e.g., bacterial vaginosis) involve an imbalance of normal flora and are characterized by **clue cells** or specific bacterial types like Gardnerella vaginalis, not intracytoplasmic gram-negative cocci. - While bacteria are present, the specific morphology and location (intracytoplasmic, gram-negative cocci) described in the urethra point away from typical vaginal bacterial infections. *Treponemal infection* - **Treponemal infections** such as **syphilis** are caused by **Treponema pallidum**, which are **spirochetes**. [1] - They are typically identified using **darkfield microscopy** or serological tests, not by observing gram-negative cocci in urethral discharge. [1]

Q: Hutchinson's Triad is specifically associated with which type of syphilis?

Congenital Syphilis. ***Congenital Syphilis*** - **Hutchinson's Triad** is a classic constellation of symptoms specific to **congenital syphilis**, reflecting the long-term effects of *in utero* infection [1]. - The triad includes **Hutchinson's teeth** (notched incisors), **interstitial keratitis** (corneal inflammation), and **sensorineural hearing loss**. *Tertiary syphilis* - This stage is characterized by **gummas**, **cardiovascular syphilis** (e.g., aortitis), and **neurosyphilis**, but not Hutchinson's triad [1]. - These manifestations develop years after initial infection in adults. *Primary syphilis* - The primary stage is marked by the appearance of a **painless chancre** at the site of infection [1]. - It does not involve the systemic, long-term complications seen in congenital syphilis. *Secondary Syphilis* - This stage typically presents with a **diffuse maculopapular rash**, **lymphadenopathy**, and sometimes **condylomata lata** [1]. - These are acute systemic symptoms, distinct from the developmental abnormalities of Hutchinson's triad.

Q: Saddle nose deformity is seen in?

Tertiary Syphilis. ***Tertiary Syphilis*** - **Saddle nose deformity** is a characteristic late manifestation of **tertiary syphilis** due to destructive lesions (gummas) affecting the nasal cartilage and bone [1], [2]. - It results from the **collapse of the nasal bridge**, leading to a flattened appearance [2]. *Primary Syphilis* - Characterized by a **chancre**, a painless ulcer, usually at the site of infection [1]. - This stage does not involve destructive lesions of the nose. *Secondary Syphilis* - Presents with a **widespread rash**, lymphadenopathy, and mucous patches [1]. - While systemic, it typically does not cause structural damage like saddle nose deformity. *Lupus Vulgaris* - This is a **cutaneous form of tuberculosis**, characterized by chronic, destructive skin lesions. - While it can cause facial disfigurement, saddle nose deformity is not a typical feature of lupus vulgaris.

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: 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.

Question 1

A 45-year-old man with a history of multiple sexual partners presents with a non-tender genital ulcer and a generalized rash. Which stage of syphilis is he likely in?

Accepted Answer

Secondary syphilis

Answer

Primary syphilis

Answer

Latent syphilis

Answer

Tertiary syphilis

Question 2

In a patient presenting with inguinal lymphadenopathy, which condition is associated with the Groove sign of Greenbalt?

Accepted Answer

Lymphogranuloma venereum (LGV)

Answer

Chancroid (Haemophilus ducreyi)

Answer

Genital Herpes (Herpes Simplex Virus)

Answer

Granuloma inguinale (Donovanosis)

Question 3

In the context of sexually transmitted infections, which condition is characterized by the presence of pseudobubo?

Accepted Answer

Lymphogranuloma inguinale

Answer

Chancroid

Answer

Syphilis

Answer

Herpes simplex

Question 4

Patient presents with discharge per urethrum and microscopy shows presence of intracytoplasmic gram negative cocci; what is the most probable diagnosis ?

Accepted Answer

Gonococcal infection

Answer

Granuloma inguinale

Answer

Vaginal bacterial infection

Answer

Treponemal infection

Question 5

Hutchinson's Triad is specifically associated with which type of syphilis?

Accepted Answer

Congenital Syphilis

Answer

Tertiary syphilis

Answer

Primary syphilis

Answer

Secondary Syphilis

Question 6

Saddle nose deformity is seen in?

Accepted Answer

Tertiary Syphilis

Answer

Primary Syphilis

Answer

Secondary Syphilis

Answer

Lupus Vulgaris

Question 7

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 8

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 9

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

Accepted Answer

Testis

Answer

Prostate

Answer

Epididymis

Answer

Urethra

Question 10

In gonorrhea, which is not a presenting feature?

Accepted Answer

Hematuria

Answer

Discharge

Answer

Reddened lips of vulva and vagina

Answer

Dysuria

Venerology — MCQs

Venerology — MCQs

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