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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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noKw ryuo SDT's aybb -); (oggni gurhtho yveer eorth cicheo no sthi qnoetisu):

  • aacieBrtl asgivnsoi eucasd by eleardrgnal lsvgainlia. eS a t,inh fof hweit dgrhecsia and siyhf mllse f(his ni het d)gnaer. ehes'rT no atniiamlfmno baL ifdnni:gs pH aeertrg nhta 4.5 tusj( ielk moirti)asosi,nhc dna a ipiotevs ifhwf sett iwht KHO. teSm will yas ehtognism tbuoa sdaoluromo ichgseadr dna shwo het mnosfiau LCEU SLELC if ew rae yul.kc Not het esnwra fro tihs euqiostn ioslvyoub ecbaeus ew dowlu ont epctex eisvlces hiwt shti aacrilebt .eesasdi

  • andiiissCda si oggin to be uroy ikcth tceotag cehese sgrechiad, thiw mtln.iiafnmao rlnmoa Hp ees oehhysapde.up terTa ihwt ialtopc niynsa,tt ro oral clazfoenolu eulnss 'yreuo agrnentp nath use mtleir.aoozlC igAan otn iggon ot ese yan lcie.esvs

  • dCioarhcn pre rwdolu si tcdsiaaeos whit liehamuopHs eidurcy ouy wlil avhe a peeD tnuplreu flapnui rlecu tiwh ptuevsiapru yeiastnphlmid. lWil be tdol ahtt iptaten ash ufiapnl ugnaliin son,ed hrete mya eb ueiltlpm eedp cslrue htiw rwygoyelal- adt.ueex uoY od cyr tihw H. iYCuRd Tish untw'ldo eb ruet orf hwat rou aintept ash in hsti iquosent buecsea ew a'nter dolt fo ayn iaiulngn t.paydoneah a nikl ot a chrnaocdi ADV

  • aimaClhdy rhtmsoiatac ceassu opluhagmlnoyrma meenevur iwchh si mllsa lhswlao ,urlsce e,aslsinp ubt nthe the agrle nlaufip eaclscdeo uaglnini yhplm ndeos aka BBSU.OE dpCraome iwht aronegnoh teh ihsregcad is orem tenrinh adn tae.ryw Aiang ont het scae heer sa tis ifulpna dna on inneotm fo yna BSUOE.OBS Teh agrhdseci in rgooehrna is omre rhc.tike hBto eadl to I,PD attre rfo thob eseuacb nfcotoince si .ocnmmo ihWt obth tntapie yma ehav smeo osrt fo ipan ro gnibrun tnieaonss puno ani.ointru eteiSlr ryaiup ghhuto for .htob

  • loydanoCm mtnmciuuaac si a tsonitaenimaf fo PHV 6 + 11 g(netlia s)atrw. They okol ekli gib o.auleclfwirs iTsh is ni srnatoct to ooCdlanmy aatl taht yuo ese ni pislhilsy hwchi is jtsu a fltatre lttae orbwn iloognk lecum.a

  • ltaineG Hesrep (teh ewansr ot the qutoiesn) lwli enrsetp hitw tupelmil unpalif rpuilacifse ieecsslv or snoelturcia tiwh cnatlnitotsuio sstpmmyo eer(v,f seaa)iml Jsut sfti ebertt tnha lla hte ohret eochsci I arn hhurtog.

  • hSiisylpl si teh ipeaslsn rhcen.ac UW rsidbscee ti sa a nsigl,e tdrinueda wlle bcimuceirdsrc ,luerc iwth a acenl ab.se See coscrkrwe rsgmnasoi no FD ioscc.yrmpo eKpe in imnd hrote islepnsa sulrce ear glnhorayupmalmo emenuevr fo daialycm tu(b the ebobus rae hwast lpiafnu ton eth lce,u)r dan roalmguan nngluaeii oai(ndvssono - elaleblsik rnguoa)ltimsa tub swhat lakmlhar oautb tsih eon si hatt tsi nliaspse whotuit hptaemalypnyhdo

nI ,orhts be f.ase

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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AF 9102 :p1g48 inlaGte rpeshe epsstnre wiht upnflia lravvu or lvacirce livescse dan uecl;rs can uasec isytecsm yopsmmst hsuc as rf,vee daahc,eeh iylmaga

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 ynobady sah a godo awy of ringmmhstennigig/birisedeu lla eth renftedif tseronetpsina for ienaglt eossr, 'Id ptcrpieeaa hte hlep.

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 is hits NTO dcanhci?ro heeTsr thionng erhe hatt elrus it tou.

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. +