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NBME 21 Answers

nbme21/Block 1/Question#39

A 33-year-old woman comes to the physician because ...

Genital herpes

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 +2  upvote downvote
submitted by gabstep(11),

FA 2019 pg184: Genital herpes presents with painful vulvar or cervical vesicles and ulcers; can cause systemic symptoms such as fever, headache, myalgia

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




If anybody has a good way of distinguishing/remembering all the different presentations for genital sores, I'd appreciate the help.

hungrybox  Pls post as a separate post and not a comment to this tho. The formatting for these comments sux +  
whossayin  Assuming u have UWorld, just type sexually transmitted infections.. that table is the best IMO +  




 +0  upvote downvote
submitted by yotsubato(380),

Why is this NOT chancroid? Theres nothing here that rules it out.

drachenx  Chancroid is described as an ulcer.. whilst in this question they mentioned "vesicles". Pretty much only herpes is vesicular +4  
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. +