NBME Step 2 CK Form 7 Genital herpes (NBME Answers)

Retired NBME Step 2 CK Form 7 Answers

step2ck_form7/Block 2/Question#3 (reveal difficulty score)
A sexually active 24-year-old man has had ...
Genital herpes 🔍 / 📺 / 🌳 / 📖
tags: infectious_disease

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submitted by ∗athleticmedic(18)

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Can anyone who got this right explain how they ruled out chancroid? This is the definition I have for chancroid which I thought fit the image/text description (multiple increasingly painful sores and lymphadenopathy), but was incorrect:

"Patients present with extremely painful suppurative ulcers that may be single or multiple.Infection begins as a papule, which quickly progresses to a pustule and subsequent ulcer formation. Painful inguinal lymphadenopathy with subsequent ulceration, usually unilateral, develops in approximately 50%."

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derpymd I'm with you on this one. I would expect to see more clustering + vesicular appearance from herpes. The topmost lesion in the image seems to have raised edges and central cavitation. Oof +

kingfriday i put down chancroid too but i think that the dark area around the lesion are supposed to be the "red base" +1

cintia05 The chancroid lesions have a well-demarcated, raised border and deeper center. +1

cintia05 The chancroid lesions have a well-demarcated, raised border and deeper center. +

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submitted by ∗drmohandes(193)

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I copy/pasted my Anki card. I think it's herpes instead of chancroid because chancroid is usually a single large ulcer.

HSV

pain? yes
lesions? multiple small vesicles
lymphadenopathy? mild

Haemophilus ducreyi == chancroid

pain? yes
lesions? single large/deep ulcer with gray/yellow exudate
lymphadenopathy? severe => produces pus eventually

Treponema pallidum == syphilis

pain? no
lesions? single, hard base, regular borders
lymphadenopathy? bilateral inguinal

Chlamydia trachomatis == lymphogranuloma venereum

pain? no
lesions? small/shallow (often missed) ulcers
lymphadenopathy? weeks later, painful, buboes

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submitted by ∗yotsubato(1208)

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Lets take a picture with a potato, JPEG the hell out of it and throw it on an exam .

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submitted by ∗seagull(1933)

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im convinced you cannot differentiate this from chancroid

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submitted by ∗step_prep5(246)

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“Dew drops on rose petals” appearance = Herpes infection
Painful genital ulcers: (1) Herpes simplex virus: Small vesicles/ulcers on erythematous base with mild lymphadenopathy (2) Chancroid: Large, deep ulcers with a soft, friable base and severe suppurative lymphadenopathy

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