Genital Ulcers - 40-item High-yield MCQ Quiz

Here is the same 40-item quiz, reformatted to match your requested exam-style layout and spacing. GENITAL ULCERS – 40-ITEM HIGH-YIELD MCQ QUIZ 1. A 22-year-old presents with painful grouped vesicles on an erythematous base that progressed to shallow ulcers plus tender inguinal nodes. Most likely cause?​ A. Treponema pallidum​ B. HSV-2​ C. Haemophilus ducreyi​ D. Klebsiella granulomatis Answer: B​ Rationale: Primary genital herpes causes painful grouped vesicles that evolve into ulcers with tender lymphadenopathy. 2. A painless, indurated 1–2 cm genital ulcer with clean non-exudative base that heals spontaneously in 2–3 weeks is most consistent with:​ A. Chancroid​ B. Primary syphilis​ C. HSV​ D. Donovanosis Answer: B​ Rationale: Primary syphilis chancre is solitary, painless, indurated, and self-limited. 3. Best single test from a genital ulcer to confirm HSV in current practice?​ A. Tzanck smear​ B. Viral culture​ C. HSV PCR/NAAT​ D. VDRL Answer: C​ Rationale: PCR/NAAT is the most sensitive test for HSV from lesions. 4. A 28-year-old has recurrent “paper-cut” vulvar fissures with mild irritation and no systemic symptoms. Diagnosis most likely?​ A. Recurrent HSV​ B. Primary syphilis​ C. Chancroid​ D. Donovanosis Answer: A​ Rationale: Recurrent HSV may present as fissures with minimal systemic symptoms. 5. Which feature most strongly supports chancroid over primary syphilis?​ A. Painless ulcer​ B. Indurated margins​ C. Painful ulcer with purulent exudate​ D. Spontaneous healing Answer: C​ Rationale: Chancroid causes painful ulcers with purulent discharge. 6. A patient with diffuse rash involving palms and soles and mucous patches most likely has:​ A. Secondary syphilis​ B. Primary HSV​ C. LGV​ D. Chancroid Answer: A​ Rationale: Palmar-plantar rash and mucous patches indicate secondary syphilis. 7. Small painless ulcer followed by painful inguinal nodes and groove sign suggests:​ A. Chancroid​ B. LGV​ C. Donovanosis​ D. HSV Answer: B​ Rationale: LGV causes transient ulcer followed by painful lymphadenopathy. 8. Proper serologic diagnosis of syphilis requires:​ A. RPR only​ B. FTA-ABS only​ C. Non-treponemal + treponemal test​ D. Darkfield only Answer: C​ Rationale: Both test types are needed due to false positives. 9. Treatment for primary syphilis:​ A. Acyclovir​ B. Benzathine penicillin G single dose​ C. Doxycycline x7 days​ D. Ceftriaxone Answer: B​ Rationale: First-line therapy is benzathine penicillin G 2.4M IM once. 10. Beefy red painless ulcer that bleeds easily suggests:​ A. Chancroid​ B. Donovanosis​ C. HSV​ D. Syphilis Answer: B​ Rationale: Donovanosis causes beefy red, vascular ulcers. 11. Donovan bodies are seen in:​ A. HSV​ B. Syphilis​ C. Donovanosis​ D. Chancroid Answer: C​ Rationale: Donovan bodies are intracellular organisms in macrophages. 12. Painful ulcer with tender suppurative nodes suggests:​ A. Syphilis​ B. Chancroid​ C. HSV​ D. LGV Answer: B​ Rationale: Chancroid causes painful ulcers with buboes. 13. Diagnosis of exclusion among genital ulcers:​ A. HSV​ B. Syphilis​ C. Chancroid​ D. LGV Answer: C​ Rationale: Chancroid often lacks definitive testing. 14. Duration of treatment for first HSV episode:​ A. 2 days​ B. 5 days​ C. 7–10 days​ D. 21 days Answer: C​ Rationale: Primary HSV requires 7–10 days of antivirals. 15. Appropriate suppressive therapy for HSV-2:​ A. Valacyclovir 1 g daily​ B. Azithromycin​ C. Penicillin​ D. Doxycycline Answer: A​ Rationale: Valacyclovir 1 g daily is standard suppressive therapy. 16. Valacyclovir 500 mg daily may be less effective in:​ A. First episode HSV​ B. ≥10 recurrences/year​ C. Primary syphilis​ D. LGV Answer: B​ Rationale: Higher-dose suppression is needed in frequent recurrences. 17. Best time to start episodic HSV therapy:​ A. After crusting​ B. Within 24 hours/prodrome​ C. After PCR​ D. After 1 week Answer: B​ Rationale: Early treatment improves efficacy. 18. Asymptomatic seropositive patient with unknown timing has:​ A. Secondary syphilis​ B. Late latent syphilis​ C. Tertiary syphilis​ D. HSV Answer: B​ Rationale: Late latent syphilis has no symptoms. 19. Treatment for late latent syphilis:​ A. Single-dose penicillin​ B. Weekly penicillin x3​ C. IV penicillin x3 days​ D. Doxycycline x7 days Answer: B​ Rationale: Three weekly IM doses are required. 20. Treatment for neurosyphilis:​ A. IM penicillin​ B. IV aqueous penicillin​ C. Azithromycin​ D. Famciclovir Answer: B​ Rationale: IV aqueous penicillin is required. 21. Fourfold rise in RPR titer after treatment indicates:​ A. Cure​ B. Lab error​ C. Reinfection/failure​ D. Prozone Answer: C​ Rationale: Suggests reinfection or treatment failure. 22. Follow-up for early syphilis:​ A. 1 and 3 months​ B. 6 and 12 months​ C. 24 months only​ D. None Answer: B​ Rationale: Early-stage follow-up is at 6 and 12 months. 23. Follow-up for late syphilis:​ A. 3 months only​ B. 6, 12, 24 months​ C. 1 year only​ D. None Answer: B​ Rationale: Extended monitoring is required. 24. HSV vs syphilis distinction:​ A. HSV painless​ B. Syphilis painful​ C. HSV vesicles → ulcers​ D. Syphilis vesicles Answer: C​ Rationale: HSV begins as vesicles. 25. HSV incubation:​ A. 3–6 days​ B. 2–12 days​ C. 10–90 days​ D. Weeks Answer: B​ Rationale: HSV incubation is 2–12 days. 26. Syphilis incubation:​ A. 2–12 days​ B. 3–6 days​ C. 10–90 days​ D. Weeks Answer: C​ Rationale: Syphilis incubates 10–90 days. 27. Chancroid incubation:​ A. 3–6 days​ B. 2 weeks​ C. Months​ D. 1 year Answer: A​ Rationale: Chancroid has short incubation. 28. Donovanosis incubation:​ A. Days​ B. Weeks​ C. 1–12 weeks​ D. Years Answer: C​ Rationale: Donovanosis develops slowly. 29. “School of fish” Gram stain:​ A. HSV​ B. Syphilis​ C. Chancroid​ D. Donovanosis Answer: C​ Rationale: Seen in H. ducreyi. 30. Ulcer most associated with HIV transmission:​ A. Chancroid​ B. LGV​ C. Syphilis​ D. HSV-1 Answer: A​ Rationale: Chancroid increases HIV risk. 31. Painful ulcers with fever and malaise suggest:​ A. HSV​ B. Syphilis​ C. Donovanosis​ D. Tertiary syphilis Answer: A​ Rationale: Primary HSV causes systemic symptoms. 32. Tingling before lesions indicates:​ A. Syphilis​ B. HSV prodrome​ C. LGV​ D. Chancroid Answer: B​ Rationale: HSV has prodromal neuropathic symptoms. 33. Best test for prior HSV exposure without lesions:​ A. Culture​ B. PCR​ C. Serology​ D. Tzanck Answer: C​ Rationale: Type-specific serology detects past exposure. 34. Best initial tests for painless ulcer:​ A. Acyclovir only​ B. Syphilis serology + HSV PCR​ C. Culture only​ D. CBC Answer: B​ Rationale: Standard evaluation includes both tests. 35. ≥12 HSV episodes/year: best management?​ A. Stop meds​ B. Suppressive therapy​ C. Penicillin​ D. Doxycycline Answer: B​ Rationale: Suppression reduces recurrence. 36. Pseudobuboes are seen in:​ A. LGV​ B. Donovanosis​ C. HSV​ D. Syphilis Answer: B​ Rationale: Donovanosis causes subcutaneous granulomas. 37. LGV treatment:​ A. Acyclovir​ B. Doxycycline x21 days​ C. Penicillin​ D. Ciprofloxacin Answer: B​ Rationale: Doxycycline for 21 days is first-line. 38. Indication for biopsy in genital lesions:​ A. Small size​ B. Induration/bleeding​ C. Pruritus​ D. Mild pain Answer: B​ Rationale: Atypical features raise concern for malignancy. 39. Early syphilis with negative serology means:​ A. Excluded​ B. Repeat testing needed​ C. Chancroid​ D. HSV Answer: B​ Rationale: Early serology may be negative. 40. Most accurate pairing:​ A. HSV painless​ B. Syphilis purulent​ C. Chancroid painful, undermined​ D. Donovanosis painful Answer: C​ Rationale: Chancroid ulcers are painful with undermined edges. If you’d like, I can next prepare a one-page “genital ulcer rapid differentiator” sheet for last-minute exam review.