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Old 10-14-2012
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Arrow Billy Step 1 Questions # 29

A 50-year-old woman comes to the health center because she has observed a small vesicle on her right labium majus.
She is sexually active. On physical examination, tender inguinal lymph nodes are palpable. She was diagnosed with
lymphoma 10 years ago. A biopsy of one of the lymph nodes is performed to exclude malignancy. Histologically, the biopsy
specimen shows multiple abscesses in which central necrosis is surrounded by palisading histiocytes. This morphology,
combined with the clinical picture, is most likely to be a complication of which of the following conditions?


□ (A) Chlamydia trachomatis cervicitis
□ (B) Herpes simplex virus infection of the perineum
□ (C) Recurrent non-Hodgkin lymphoma
□ (D) Candida albicans vaginitis
□ (E) Gardnerella vaginalis vaginosis
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Old 10-14-2012
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(B) Herpes simplex virus infection of the perineum
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A. LGV.... Multiple abscesses
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□ (A) Chlamydia trachomatis cervicitis
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Correct Answer A is correct

Infection with Chlamydia trachomatis is a common sexually transmitted disease. Most cases produce only urethritis
and cervicitis; however, some strains of C. trachomatis can produce lymphogranuloma venereum, a chronic ulcerative
disease that is more endemic in Asia, Africa, and the Caribbean. In this disease, there is a mixed granulomatous and
neutrophilic inflammatory reaction, as seen in this patient. In contrast, herpes simplex virus produces clear mucocutaneous
vesicles with no exudates and is unlikely to involve lymph nodes. Recurrent lymphoma is characterized by sheets or
nodules of pleomorphic lymphocytes without significant inflammation. Candidiasis can produce superficial inflammation
with an exudate, but it is rarely invasive or disseminated in non-immunosuppressed individuals. Bacterial vaginosis due to
Gardnerella produces a whitish discharge that has a “fishy” odor.
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