MODULE 3 — BOARD EXAM BUNDLE | Acute Dysuria, Pelvic Pain & Vaginal Discharge Page 1
MODULE 3
Board Exam Preparation Bundle
Acute Dysuria, Pelvic Pain & Vaginal Discharge in Young Female Patients
25 USMLE Step 2 CK / ANCC / AANP Board-Style Vignette Questions With
Expert Rationales & Distractor Analysis
■ Format ■ Time ■ Focus ■ Topics
25 Clinical Vignette MCQs 50 Minutes 2 Minutes Per Clinical Judgment Next Best STIs · PID · UTI · BV · VVC
USMLE Step 2 CK / ANCC / Question Management Steps Physical Trichomonas · IC/BPS ·
AANP Style Exam Interpretation Pharmacology
■ CLINICAL GUIDELINES BASIS:
All questions are based on CDC 2021 STI Treatment Guidelines, ACOG Clinical Practice Bulletins, IDSA Guidelines for UTI
Management, and AUGS/SUFU Guidelines for IC/BPS. Clinical vignettes are fictional composites for educational use only.
© Clinical Revision Masterclass — For Educational Use Only | Based on CDC 2021, ACOG, IDSA Guidelines USMLE Step 2 CK · ANCC · AANP Board Preparation
,MODULE 3 — BOARD EXAM BUNDLE | Acute Dysuria, Pelvic Pain & Vaginal Discharge Page 2
SECTION A — EXAMINATION INSTRUCTIONS & TOPIC
OVERVIEW
■ EXAMINATION FORMAT:
This examination contains 25 board-style clinical vignette questions. Each question has ONE correct answer. Questions are
designed to test clinical reasoning, pharmacological knowledge, guideline application, and physical examination interpretation
at the level expected on USMLE Step 2 CK, ANCC Family/Adult Health NP, and AANP certification examinations.
Topic Area Questions Key Concepts Tested
STI Diagnosis & Treatment Q1, Q6, Q7, Q9, NAAT vs. culture, CDC 2021 regimen updates,
(GC, Chlamydia, Trichomonas) Q17, Q20 dual therapy, EPT, penicillin allergy alternatives
PID & TOA Management Q2, Q12, Q16, Minimum treatment criteria, TOA escalation,
Q24 Chandelier sign, inpatient vs. outpatient criteria
Pyelonephritis & Upper UTI Q3, Q10 WBC casts, pregnancy management,
hospitalization criteria, IV regimens
Bacterial Vaginosis Q4, Q11, Q18, Amsel criteria, recurrence protocol,
Q19, Q21 pregnancy treatment, pathophysiology
Vulvovaginal Candidiasis Q5, Q15, Q23 Pregnancy restrictions, RVVC suppression,
satellite lesions, species identification
Urinalysis & IC/BPS Q8, Q10 WBC casts, glomerulations, Hunner lesions,
IC/BPS diagnosis of exclusion
Drug Safety & Pharmacology Q3, Q5, Q14, Pregnancy contraindications, renal impairment,
Q22 allergy management, mechanism-based selection
Comprehensive Management Q17, Q18, Q25 Public health reporting, EPT, test-of-cure
timing, screening obligations
■ HIGH-YIELD EXAM PEARLS:
IMPORTANT EXAM TIPS: (1) Always check for pregnancy status — it dramatically alters pharmacological management. (2)
CDC 2021 updated Chlamydia first-line from azithromycin to doxycycline — know this change. (3) PID minimum treatment
criteria: ANY ONE of CMT, uterine tenderness, or adnexal tenderness is sufficient. (4) WBC casts = pathognomonic for upper
tract (renal parenchymal) disease. (5) Wet mount has only 51-65% sensitivity for Trichomonas — NAAT is gold standard.
© Clinical Revision Masterclass — For Educational Use Only | Based on CDC 2021, ACOG, IDSA Guidelines USMLE Step 2 CK · ANCC · AANP Board Preparation
,MODULE 3 — BOARD EXAM BUNDLE | Acute Dysuria, Pelvic Pain & Vaginal Discharge Page 3
SECTION B — CLINICAL VIGNETTE EXAMINATION
(Questions 1–25)
Instructions: For each question, select the SINGLE BEST answer. Recommended time: 50 minutes (2 minutes per
question). Answer key and detailed rationales are provided in Section C.
Q1 — STI Diagnosis & Treatment
Question 1. A 23-year-old woman presents with 2 days of dysuria, urinary frequency, and a mucopurulent cervical
discharge. She has one new sexual partner in the past month and uses oral contraceptives. Urinalysis shows pyuria with
negative nitrites. A Gram stain of cervical discharge reveals intracellular Gram-negative diplococci. Which of the
following is the MOST appropriate next step?
A. Prescribe nitrofurantoin 100 mg BID × 5 days
B. Order NAAT for Neisseria gonorrhoeae and Chlamydia trachomatis and treat empirically while awaiting results
C. Prescribe trimethoprim-sulfamethoxazole (TMP-SMX) DS BID × 3 days
D. Reassure the patient and advise increased fluid intake
E. Prescribe oral doxycycline 100 mg BID × 7 days as monotherapy
Q2 — PID Management
Question 2. A 19-year-old woman presents with lower abdominal pain for 3 days, fever (38.4°C), and vaginal discharge.
On bimanual examination, she has cervical motion tenderness and bilateral adnexal tenderness. Urine hCG is negative.
NAAT results are pending. Which of the following is the MOST appropriate management?
A. Await NAAT results before initiating any treatment
B. Admit to hospital for IV antibiotics immediately
C. Begin empiric outpatient treatment with ceftriaxone IM + doxycycline PO + metronidazole PO
D. Prescribe oral azithromycin 1g as single-dose therapy
E. Perform diagnostic laparoscopy to confirm PID before treating
Q3 — Pyelonephritis in Pregnancy
Question 3. A 26-year-old woman at 18 weeks gestation presents with fever (39.1°C), right flank pain, costovertebral
angle tenderness, nausea, and vomiting. Urinalysis shows numerous WBCs, WBC casts, bacteriuria, and positive
nitrites. Which of the following is the MOST appropriate management?
A. Outpatient nitrofurantoin 100 mg BID × 7 days
B. Outpatient ciprofloxacin 500 mg BID × 7 days
C. Hospitalization with IV ceftriaxone 1g Q24h
D. Outpatient fosfomycin 3g single-dose granules
E. Outpatient doxycycline 100 mg BID × 14 days
© Clinical Revision Masterclass — For Educational Use Only | Based on CDC 2021, ACOG, IDSA Guidelines USMLE Step 2 CK · ANCC · AANP Board Preparation
, MODULE 3 — BOARD EXAM BUNDLE | Acute Dysuria, Pelvic Pain & Vaginal Discharge Page 4
Q4 — Bacterial Vaginosis Treatment
Question 4. A 25-year-old woman presents with a thin, gray-white, homogeneous vaginal discharge with a 'fishy' odor,
worse after intercourse. She denies pruritus. Vaginal pH is 5.2. Wet mount reveals clue cells and a positive whiff test.
Which of the following is the MOST appropriate treatment?
A. Metronidazole 2g PO single dose
B. Metronidazole 500 mg PO BID × 7 days
C. Fluconazole 150 mg PO single dose
D. Treat both the patient and her sexual partner with metronidazole 500 mg BID × 7 days
E. Clindamycin 300 mg PO BID × 7 days with simultaneous partner treatment
Q5 — VVC in Pregnancy
Question 5. A 24-year-old woman at 16 weeks gestation presents with intense vaginal pruritus, thick white 'cottage
cheese' discharge, and vulvar erythema. Vaginal pH is 4.2. Wet mount shows budding yeast and pseudohyphae. Which
is the MOST appropriate treatment?
A. Fluconazole 150 mg PO single dose
B. Metronidazole 500 mg PO BID × 7 days
C. Clotrimazole 1% cream intravaginally × 7 days
D. Boric acid vaginal suppositories 600 mg daily × 14 days
E. Itraconazole 200 mg PO BID × 3 days
Q6 — Trichomonas Diagnosis
Question 6. A 21-year-old woman presents with frothy, yellow-green vaginal discharge, vulvar irritation, and dysuria.
Vaginal pH is 6.0. Wet mount microscopy is performed but shows no organisms. NAAT for GC is pending. Which of the
following best explains the absent organisms and what is the MOST appropriate next step?
A. Findings are consistent with BV; treat with metronidazole
B. Wet mount has low sensitivity for Trichomonas; send NAAT for T. vaginalis
C. Obtain a colposcopy to evaluate for cervical dysplasia
D. The negative wet mount excludes Trichomonas; investigate for contact dermatitis
E. Prescribe empiric fluconazole for presumed yeast infection
Q7 — Chlamydia Treatment — CDC 2021 Update
Question 7. A 22-year-old woman is diagnosed with uncomplicated genital Chlamydia trachomatis infection via NAAT.
She has no drug allergies. Which of the following is the MOST appropriate first-line treatment per current CDC 2021
guidelines?
A. Azithromycin 1g PO single dose
B. Doxycycline 100 mg PO BID × 7 days
C. Levofloxacin 500 mg PO daily × 7 days
D. Ceftriaxone 500 mg IM × 1 dose plus azithromycin 1g PO
E. Erythromycin base 500 mg PO QID × 7 days
© Clinical Revision Masterclass — For Educational Use Only | Based on CDC 2021, ACOG, IDSA Guidelines USMLE Step 2 CK · ANCC · AANP Board Preparation
MODULE 3
Board Exam Preparation Bundle
Acute Dysuria, Pelvic Pain & Vaginal Discharge in Young Female Patients
25 USMLE Step 2 CK / ANCC / AANP Board-Style Vignette Questions With
Expert Rationales & Distractor Analysis
■ Format ■ Time ■ Focus ■ Topics
25 Clinical Vignette MCQs 50 Minutes 2 Minutes Per Clinical Judgment Next Best STIs · PID · UTI · BV · VVC
USMLE Step 2 CK / ANCC / Question Management Steps Physical Trichomonas · IC/BPS ·
AANP Style Exam Interpretation Pharmacology
■ CLINICAL GUIDELINES BASIS:
All questions are based on CDC 2021 STI Treatment Guidelines, ACOG Clinical Practice Bulletins, IDSA Guidelines for UTI
Management, and AUGS/SUFU Guidelines for IC/BPS. Clinical vignettes are fictional composites for educational use only.
© Clinical Revision Masterclass — For Educational Use Only | Based on CDC 2021, ACOG, IDSA Guidelines USMLE Step 2 CK · ANCC · AANP Board Preparation
,MODULE 3 — BOARD EXAM BUNDLE | Acute Dysuria, Pelvic Pain & Vaginal Discharge Page 2
SECTION A — EXAMINATION INSTRUCTIONS & TOPIC
OVERVIEW
■ EXAMINATION FORMAT:
This examination contains 25 board-style clinical vignette questions. Each question has ONE correct answer. Questions are
designed to test clinical reasoning, pharmacological knowledge, guideline application, and physical examination interpretation
at the level expected on USMLE Step 2 CK, ANCC Family/Adult Health NP, and AANP certification examinations.
Topic Area Questions Key Concepts Tested
STI Diagnosis & Treatment Q1, Q6, Q7, Q9, NAAT vs. culture, CDC 2021 regimen updates,
(GC, Chlamydia, Trichomonas) Q17, Q20 dual therapy, EPT, penicillin allergy alternatives
PID & TOA Management Q2, Q12, Q16, Minimum treatment criteria, TOA escalation,
Q24 Chandelier sign, inpatient vs. outpatient criteria
Pyelonephritis & Upper UTI Q3, Q10 WBC casts, pregnancy management,
hospitalization criteria, IV regimens
Bacterial Vaginosis Q4, Q11, Q18, Amsel criteria, recurrence protocol,
Q19, Q21 pregnancy treatment, pathophysiology
Vulvovaginal Candidiasis Q5, Q15, Q23 Pregnancy restrictions, RVVC suppression,
satellite lesions, species identification
Urinalysis & IC/BPS Q8, Q10 WBC casts, glomerulations, Hunner lesions,
IC/BPS diagnosis of exclusion
Drug Safety & Pharmacology Q3, Q5, Q14, Pregnancy contraindications, renal impairment,
Q22 allergy management, mechanism-based selection
Comprehensive Management Q17, Q18, Q25 Public health reporting, EPT, test-of-cure
timing, screening obligations
■ HIGH-YIELD EXAM PEARLS:
IMPORTANT EXAM TIPS: (1) Always check for pregnancy status — it dramatically alters pharmacological management. (2)
CDC 2021 updated Chlamydia first-line from azithromycin to doxycycline — know this change. (3) PID minimum treatment
criteria: ANY ONE of CMT, uterine tenderness, or adnexal tenderness is sufficient. (4) WBC casts = pathognomonic for upper
tract (renal parenchymal) disease. (5) Wet mount has only 51-65% sensitivity for Trichomonas — NAAT is gold standard.
© Clinical Revision Masterclass — For Educational Use Only | Based on CDC 2021, ACOG, IDSA Guidelines USMLE Step 2 CK · ANCC · AANP Board Preparation
,MODULE 3 — BOARD EXAM BUNDLE | Acute Dysuria, Pelvic Pain & Vaginal Discharge Page 3
SECTION B — CLINICAL VIGNETTE EXAMINATION
(Questions 1–25)
Instructions: For each question, select the SINGLE BEST answer. Recommended time: 50 minutes (2 minutes per
question). Answer key and detailed rationales are provided in Section C.
Q1 — STI Diagnosis & Treatment
Question 1. A 23-year-old woman presents with 2 days of dysuria, urinary frequency, and a mucopurulent cervical
discharge. She has one new sexual partner in the past month and uses oral contraceptives. Urinalysis shows pyuria with
negative nitrites. A Gram stain of cervical discharge reveals intracellular Gram-negative diplococci. Which of the
following is the MOST appropriate next step?
A. Prescribe nitrofurantoin 100 mg BID × 5 days
B. Order NAAT for Neisseria gonorrhoeae and Chlamydia trachomatis and treat empirically while awaiting results
C. Prescribe trimethoprim-sulfamethoxazole (TMP-SMX) DS BID × 3 days
D. Reassure the patient and advise increased fluid intake
E. Prescribe oral doxycycline 100 mg BID × 7 days as monotherapy
Q2 — PID Management
Question 2. A 19-year-old woman presents with lower abdominal pain for 3 days, fever (38.4°C), and vaginal discharge.
On bimanual examination, she has cervical motion tenderness and bilateral adnexal tenderness. Urine hCG is negative.
NAAT results are pending. Which of the following is the MOST appropriate management?
A. Await NAAT results before initiating any treatment
B. Admit to hospital for IV antibiotics immediately
C. Begin empiric outpatient treatment with ceftriaxone IM + doxycycline PO + metronidazole PO
D. Prescribe oral azithromycin 1g as single-dose therapy
E. Perform diagnostic laparoscopy to confirm PID before treating
Q3 — Pyelonephritis in Pregnancy
Question 3. A 26-year-old woman at 18 weeks gestation presents with fever (39.1°C), right flank pain, costovertebral
angle tenderness, nausea, and vomiting. Urinalysis shows numerous WBCs, WBC casts, bacteriuria, and positive
nitrites. Which of the following is the MOST appropriate management?
A. Outpatient nitrofurantoin 100 mg BID × 7 days
B. Outpatient ciprofloxacin 500 mg BID × 7 days
C. Hospitalization with IV ceftriaxone 1g Q24h
D. Outpatient fosfomycin 3g single-dose granules
E. Outpatient doxycycline 100 mg BID × 14 days
© Clinical Revision Masterclass — For Educational Use Only | Based on CDC 2021, ACOG, IDSA Guidelines USMLE Step 2 CK · ANCC · AANP Board Preparation
, MODULE 3 — BOARD EXAM BUNDLE | Acute Dysuria, Pelvic Pain & Vaginal Discharge Page 4
Q4 — Bacterial Vaginosis Treatment
Question 4. A 25-year-old woman presents with a thin, gray-white, homogeneous vaginal discharge with a 'fishy' odor,
worse after intercourse. She denies pruritus. Vaginal pH is 5.2. Wet mount reveals clue cells and a positive whiff test.
Which of the following is the MOST appropriate treatment?
A. Metronidazole 2g PO single dose
B. Metronidazole 500 mg PO BID × 7 days
C. Fluconazole 150 mg PO single dose
D. Treat both the patient and her sexual partner with metronidazole 500 mg BID × 7 days
E. Clindamycin 300 mg PO BID × 7 days with simultaneous partner treatment
Q5 — VVC in Pregnancy
Question 5. A 24-year-old woman at 16 weeks gestation presents with intense vaginal pruritus, thick white 'cottage
cheese' discharge, and vulvar erythema. Vaginal pH is 4.2. Wet mount shows budding yeast and pseudohyphae. Which
is the MOST appropriate treatment?
A. Fluconazole 150 mg PO single dose
B. Metronidazole 500 mg PO BID × 7 days
C. Clotrimazole 1% cream intravaginally × 7 days
D. Boric acid vaginal suppositories 600 mg daily × 14 days
E. Itraconazole 200 mg PO BID × 3 days
Q6 — Trichomonas Diagnosis
Question 6. A 21-year-old woman presents with frothy, yellow-green vaginal discharge, vulvar irritation, and dysuria.
Vaginal pH is 6.0. Wet mount microscopy is performed but shows no organisms. NAAT for GC is pending. Which of the
following best explains the absent organisms and what is the MOST appropriate next step?
A. Findings are consistent with BV; treat with metronidazole
B. Wet mount has low sensitivity for Trichomonas; send NAAT for T. vaginalis
C. Obtain a colposcopy to evaluate for cervical dysplasia
D. The negative wet mount excludes Trichomonas; investigate for contact dermatitis
E. Prescribe empiric fluconazole for presumed yeast infection
Q7 — Chlamydia Treatment — CDC 2021 Update
Question 7. A 22-year-old woman is diagnosed with uncomplicated genital Chlamydia trachomatis infection via NAAT.
She has no drug allergies. Which of the following is the MOST appropriate first-line treatment per current CDC 2021
guidelines?
A. Azithromycin 1g PO single dose
B. Doxycycline 100 mg PO BID × 7 days
C. Levofloxacin 500 mg PO daily × 7 days
D. Ceftriaxone 500 mg IM × 1 dose plus azithromycin 1g PO
E. Erythromycin base 500 mg PO QID × 7 days
© Clinical Revision Masterclass — For Educational Use Only | Based on CDC 2021, ACOG, IDSA Guidelines USMLE Step 2 CK · ANCC · AANP Board Preparation
