USMLE-Rx Step 2 Practice Q's

USMLE-Rx Step 2 Qmax Challenge #21125

Check out today’s Step 2 CK Qmax Question Challenge.

Know the answer? Post it in the comments below! Don’t forget to check back for an update with the correct answer and explanation (we’ll post it in the comments section below).

USMLE-Rx Step 2 Qmax Challenge #21125A 19-year-old patient presents to her gynecologist complaining of a painful genital rash (see image). The patient states that approximately 1 week ago she had unprotected sexual intercourse with a new partner. She denies any vaginal pruritus or discharge, abdominal pain, fevers, dysuria, or vaginal bleeding.

In addition to local care for the lesions, what is the most appropriate treatment for this condition?

A. Efavirenz
B. Fluconazole
C. Metronidazole
D. Topical trichloroacetic acid
E. Valacyclovir

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3 replies »

  1. The correct answer is E. The painful vesicular nature of her lesions and the short incubation time between exposure and symptoms indicate that this patient is suffering from genital herpes. Genital herpes is most often caused by herpes simplex virus-2. Valacyclovir is an antiviral medication that is used to treat primary and recurrent episodes of genital herpes, as well as for suppression therapy to reduce the frequency of genital herpes recurrences.

    A is not correct. Efavirenz is a non-nucleoside reverse transcriptase inhibitor. It prevents the reverse transcription of virus RNA into DNA. Thus it is effective treatment for a retrovirus such as HIV. However, it is not effective against a DNA virus such as herpes simplex virus, which does not rely on reverse transcriptase for replication.

    B is not correct. Fluconazole is an antifungal agent that inhibits fungal cell membrane synthesis, and thus is not active against the herpes simplex virus. It would not be useful in the treatment of genital herpes.

    C is not correct. Metronidazole is an antibiotic that is effective in treating anaerobic bacteria and some protozoa. It is used to treat bacterial vaginosis and Trichomonas infections, but is ineffective against viruses such as herpes simplex virus.

    D is not correct. Treatment with topical trichloroacetic acid is often used to treat the condyloma acuminata lesions caused by the human papillomavirus. It is not used in the treatment of the vesicular lesions of genital herpes.

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