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NBME 21 Answers

nbme21/Block 1/Question#39 (reveal difficulty score)
A 33-year-old woman comes to the physician ...
Genital herpes ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ
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 +40 
submitted by โˆ—lsmarshall(445),
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eraU cylCe irdsorseD t&;g saIetodl vseree mrmnheyomepiaa &(g;t 010;0 ,i..e on trheo eeserv bailmotec niactbusersd

Oiehtrinn rmtasyeralabscna eicdcfneyi g&t; otm(s commno ruae leycc is.)d otorci cdiaiudraceiama/i, nepommeaarhmiy

rngOcai dimAecasi g&;t eeyHroaamin,mmp iagnpa-no coisiasd, seistko fro(m yhalcieoypgm)

amhed-iicnMu CyAcol-a rghyaeeddnsoe ieyndcceif &;gt oaimerHpmyne,am ohyitctokpe yepycihlogam ens(e in daoฮฒintxo-i orsrided,s PTECXE apkdtorls)oendryyuheo

Lervi dfntinsucyo &;gt oer,aameHpmnmiy LFTs seesmd ,pu eorld .pt


 +31 
submitted by โˆ—madojo(189),
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noKw royu DTsS' ybba ;-) igngo( htguhro veyer oehrt hoicec on tsih iuq)not:es

  • citrleBaa oasivnsig ecausd yb lrngdarlaee iligaaslnv. Se a tn,hi fof hitew iedhagcsr nad hisyf emlls hsfi( in eth .ardgn)e rhee'sT no lmtiinaafnmo Lab igsnni:fd Hp regrtae anht .54 jus(t klei mhsi)nisoacot,ri dan a tpsioevi hfiwf etst twhi HKO. Smte lilw say gseiotnmh uobta odrluooasm cdiehsagr dna hwso hte snmiouaf CULE LCELS if ew are .luykc Nto eth wnaesr for hsti qesuonit iuyvsbool ceausbe we ldwuo ont ctexpe silescve thwi hits ielcbarat ssedeia.

  • idissndaiaC is gingo ot be royu tkhic tcaeotg heesce hsegdrica, thiw maiitnlom.fna nolmra pH see epopdehhyu.sa traeT htwi iplocat nn,ittays or aorl zolcoafelnu senusl ou'yre renntgap tnha seu lC.zorotmleai nAagi nto gniog ot ese yan lsesev.ic

  • hdrCinaoc per wrloud si sadiecsato tihw uieoamlHsph diuryce you will evah a peDe etlupurn lfpnaui cleur tihw piusrpaetvu lnpdieh.mytais liWl be ldto ttah ntieatp ash liapufn ngiiunla e,dosn eethr yma eb uitellpm eped cuelrs ithw lyelawy-gro ed.txuae You do yrc thiw .H dYRuiC ihTs tol'dunw eb rtue rof wath rou itptena ahs in ihts sntqeoui aesbcue ew 'rneat otdl fo nya uiniangl aanydepot.h a kiln ot a cdihnorac VDA

  • ilaCyhamd hraaticsmot sascue plmologuyanahmr nremveeu hiwhc is lsalm swlahlo clruse, easipln,s but hnte the alreg paunlif leaodcsce lugnanii lmyhp nesdo aka BSOEU.B derpoCam hwti ognnhroea het heacdsrgi is erom tneirnh dan .tyewra giAna ont hte easc eerh sa sit naflpui and on mitoenn fo any BOSU.OEBS The sdighcrea in rhgenorao si orme cierkth. Both dlae to DIP, trate for othb bucaees nfnoeoicct is cmoon.m ithW btoh tanteip amy eavh emos stor fo aipn or bnruing taoesnsin unpo traonniu.i rieeSlt apryiu uhhgot rof .both

  • aldonomCy uciuaamnctm is a mtfanoiaients fo HPV 6 + 11 tangile( t.)sraw eThy kolo klei ibg oeslcarwlui.f ihTs si in ttaonscr to oanldCmyo laat htta uyo ese ni lhipsysli hiwch is utsj a areftlt eatlt nborw lokigon u.aceml

  • alnietG rspeHe (eth esanwr ot the sneqiuot) wlli eerspnt with pllmitue nfiupla uacprsfieli seivcsle ro ntucsaoeirl ihtw acoitsitotunnl ommsptsy ,refev( )eaalsmi Juts tfis reetbt htna all teh ertoh seihocc I nar rhgutoh.

  • siyShplli is teh paneliss .cahercn WU rcisdsebe it as a n,igesl ntdduirea elwl rdciebcrmcsui er,ucl with a lance abse. eSe crewcsork iamnrosgs on DF coiorps.cym Keep ni indm teorh anspisle eurcsl rae yomoalpuarmnghl nemevure of ilaydcma bt(u teh ebbsuo rae ahtws ipalunf ton teh ,ecu)rl dan gamulrano inanulige nsovasn(odoi - blslieklae aouir)ntlagsm btu hsatw makhallr ubaot hist noe is hatt tsi neislaps owuthit yhhtameyppoanld

In thsro, eb fs.ae

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 1209 1:4pg8 alGeint heersp serptsne wiht fialnpu luvrav ro craivecl elisevcs dna curs;el nca seuca etcmsysi yospsmmt schu sa ,fvree ech,ehaad mylaiga

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 โˆ—tissue creep(120),
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fI yyondba hsa a oogd wya of b/igtiermminhnnregdgueissi all eht endifretf aesretnintosp rof iaeltng ,eosrs 'Id raeiptcpea het 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 โˆ—yotsubato(1121),
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Wyh is tshi TNO hcrnaoc?id eehTsr nihontg ehre tath elsur ti 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. +  



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