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NBME 21 Answers

nbme21/Block 1/Question#39 (39.2 difficulty score)
A 33-year-old woman comes to the physician ...
Genital herpes🔍,📺
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 +28 
submitted by madojo(182),
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nwoK yrou SDsT' baby )-; oign(g guhthro yerve rohet eoccih on this oq)sntie:u

  • laeriBact givnsiaos aduces yb garrelnelad vnilasgali. Se a tihn, off etwhi iashrcdge nad hyfis lsmel f(ish ni eht dgea)nr. sT'rehe no foimaalmitnn Lba g:ninfsid pH ergtera nhta .54 (tjsu elki mioitirh)s,oncsa dan a stvepioi iffhw test hwti OHK. Smte iwll asy heisntmgo butao sudmooralo easrdcihg dan sohw the aoimnsuf LUCE LELCS if we ear uc.lyk Nto het enrwas ofr ihts qtsneuoi olbsvioyu sebacue we luwod otn eexcpt slvieces wtih hsit labeicart deie.ssa

  • iinsCddasai si oigng to be uory itchk coteatg chseee iacgesdrh, tihw nimlfanoita.m nmoarl pH ese phyepsehudo.a rTaet thiw octlpai sttnai,ny or arol uonflaozecl lusesn ruoy'e nargntep naht esu azoCi.lorlmte gAani nto ongig to ees ayn icssl.eve

  • idrnhoaCc rpe wrlodu is adtsacieos hitw Hhulamipeos urdeciy yuo lwli have a eeDp utperunl lipunaf ruecl thiw eivrustppau amtsdli.iyenhp llWi eb ltdo that nietatp ahs aplufni nluagnii n,osed theer mya be etliplmu depe rclesu hwit wlrgaoyel-y daetuxe. ouY do ryc thwi H. diCYuR iTsh 'lwtudon eb uter rof waht uro nipteta ahs ni iths ieotsnuq sebceua ew etan'r dtlo of nya iugnailn phnd.yataoe a likn to a nahidorcc DVA

  • adhymClai romsitacaht suaecs mlpoalaumynrhgo eeemnurv hwhic is lmasl lohwlas su,lrce ei,slsanp tub htne teh gelar uipalnf lsoedacce nilnuiag lymhp dnsoe kaa BESUOB. mreCdpoa hwti renhgonao eht hresiacdg si ermo trnehni and r.eytaw nagAi ont eht esac rhee sa ist ialpfnu dan no inteomn fo nay B.OSOBESU eTh isagcerhd ni oagnorerh si meor h.tciker Btoh elad ot DIP, atetr ofr otbh abcuees coinnoctef is cmo.onm htWi hbto teiatpn aym aevh mose stro fo npia or brngniu aseinnsto ponu ii.nunarto Sitlere uyapir gtuohh rfo bth.o

  • yoadClmno nimacmcauut si a niseiataonfmt fo HVP 6 + 11 tegi(lna t)w.sra heyT look kile bgi lcueis.foalwr Tish si in rcttsano ot Caomonldy laat taht uyo see in ilhlsypis hchwi is sjtu a altfrte eltta wbonr likongo lmacu.e

  • naeGtil pHesre (eht wsaern to eht euointqs) iwll eensprt twih eltlmiup flpunai rpufcesilai ecsvlise or sneloitruca ithw snatictotluoin mypmotss v,ere(f asa)mlie suJt tfis bteret hnat lal eht roeth hceicos I nra rhoght.u

  • lsiyhplSi is het lsinpesa .archcen UW crebesdis it as a glei,sn dtinuaerd lewl cscbdrimeucri ,rcleu wiht a lnaec abs.e eSe oksecwrrc rssgamoin no DF spmio.orycc Keep ni mdin rheto sspneial scurle era monoaglmlraphyu meenveru fo iyadclma tb(u teh oesubb aer aswth puflnai otn hte luc,)er dna ruolmnaga innaieulg onodvnasoi(s - keseliblla lmasan)guoirt btu tsawh amklahrl baout tish oen is ttah its nesailsp owthuit dtaomnyalpehphy

nI oh,tsr be .asfe

drdoom  this write-up is AWESOME ... but it also made me vomit. +  
b1ackcoffee  This is awesome, writeup, not the stds. +  
lovebug  FA 2019 pg 184. I summed up @madojo's comment! this patient have "multiple, tender vesicles and ulcer". and scant vaginal discharge. A) Bacterial vaginosis -> NO vesicle -> r/o B) Candidiasis -> NO vesicle -> r/o C) Chancroid -> should have Inguinal Adenopathy -> r/o D) C. trachomatis -> have Large painful inguinal LN -> r/o E) Condyloma acuminata -> Big Cauliflower -> r/o F) Gental herpes -> YES!!! G) Gonorrhea -> NO Vesicle, creamy prulent discharge -> r/o H) C. trachomatis again (same as D) -> r/o I) Syphilis -> painless chancre -> r/o J) Trichomoniasis -> strawberry cervix, motile in wet prep -> r/o thanks @madojo! +  
homersimpson  Gotta love the BUBOES +  



 +3 
submitted by gabstep(14),
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FA 9012 148pg: iGenlta srpeeh steprens iwth iflupan rvuvla ro avcieclr sleicves and ercl;us anc aecsu tyemssci tmoyssmp chus sa erv,fe cadh,eaeh imgalya

sam.l  the question stem states a "a scent vaginal discharge" is that a distractor in the question. +  
kentuckyfan  "Scant" means very little. +1  



 +2 
submitted by tissue creep(117),
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If byyoand sah a oodg ayw fo nushtigieie/gmidsernngbimr lal eth tefdiefrn aestrnotnepis ofr agnleit eros,s d'I itpaecprea teh hple.

hungrybox  Pls post as a separate post and not a comment to this tho. The formatting for these comments sux +1  
whossayin  Assuming u have UWorld, just type sexually transmitted infections.. that table is the best IMO +  
lumd  Thank you so much for the tip! Didn't know that you can search for specific topics in UW. +  



 +0 
submitted by yotsubato(1086),
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Wyh si shit OTN nh?icdoarc Threse oihntng ereh hatt erlsu it out.

drachenx  Chancroid is described as an ulcer.. whilst in this question they mentioned "vesicles". Pretty much only herpes is vesicular +6  
whoissaad  They mentioned ulcers too. I chose chancroid as well, couldn't find a clue to rule it out. Also thought "discharge" was pointing you towards a bacterial infection. But guess I'm wrong :) +  
emmy2k21  I think NBME/USMLE writers make the assumption the patient is in America unless specified otherwise. Chancroid is not common in the US. If the question stem mentions a developing country, then chancroid can make your differential list. +1  
selectuw  for chancroid, there may be a mention of inguinal lymphadenopathy +2  
samsam3711  Also with chancroid questions they want you to differentiate it between chancroid and syphilis, (eg. Painful vs. painless) and is usually described as a much larger ulcer that is painful (not vesicular as in this question) +  
suckitnbme  Also believe that chancroid does not presents with systemic symptoms like in this vignette. +