BC Vag Discharge, Vag pruritis

Question 1

What is the N vag pH

Answer 1

<4.5 (3.8 - 4.2)

Question 2

What does physiological dx present as

Answer 2

clear, white, flocculent

Question 3

Is it normal to have lactobacilli and epithelial cells on smear of vag discharge?

Answer 3

Yes

Question 4

When does physiological discharge increase?

Answer 4

any high estrogen states (pregnancy, OCP, mid cycle, PCOS)

Question 5

pH <4.5 what is the discharge likely to be

Answer 5

Physiologic or candidia albicans

Question 6

A 15 yo girl is brought to the ER c/o nausea, vomiting, and lower abdominal pain since 4 days. Her last menstrual period was 9 days ago. She is sexually active and does not use contraception. Her temp is 39.7°C, pulse is 105/min, and BP is 110/75 mmHg. Physical exam shows bilateral lower abdominal tenderness and peritoneal signs. Pelvic exam reveals a copious yellow cervical discharge and exquisite cervical motion tenderness

Which of the following is the most appropriate next step in management?

a) Admission to the hospital for laparoscopy
b) Admission to the hospital for laprotomy
c) Admission to the hospital for IV antibiotic therapy
d) Discharge with analgesic therapy
e) CT scan of the pelvic
f) Discharge with oral antibiotic therapy only
g) Discharge with oral and intramuscular antibiotic therapy only
h) MRI of the pelvis
i) Uterine evaluation in the emergency department
j) Uterine evaluation in the operating room
k) Limited-stay observation and evaluation

Answer 6

Admission fo IV abx

Question 7

A 51 year old woman complains of recurrent vulvar pruritus and dyspareunia. On examination, the vulvar is erythematous, moist and the labia is swollen. There are erythematous sattelite lesions on her inner thighs and groin. Which of the following conditions is the most likely pre-disposing factor?

a) Chronic urinary tract infections
b) Menopause
c) Diabetes
d) Herpes genitalis
e) Pediculosis pubis

Answer 7

DM

Question 8

Does BV cause vulvavaginal irritation?

Answer 8

NO

Question 9

Do you treat asymptomatic BV with someone who isn’t pregnant?

Answer 9

NO

Question 10

if patient has fishy door after sex what do you treat with

Answer 10

Metronidazole

Question 11

A 5 yo girl is brought to the ER after blood was noted on her underpants. She has been rubbing and itching her genital area for the past 5 days however. Her mother states she has also had a foul-smelling discharge and burning in the affected area, which was worse with urination.Temp is 37°C. Exam shows a green vaginal discharge and diffuse inflammation of the vulva. The hymen appears intact and there are no lacerations, ecchymoses, or other signs of trauma. A wet mount preparation of the discharge shows occasional erythrocytes and numerous leukocytes. Culture of the discharge shows polymicrobial infection

Which of the following is the most likely cause of these symptoms.

a) Inoculation from an upper respiratory tract infection
b) Urinary tract infection
c) Vaginal foreign body
d) Sarcoma botryoides
e) Gastroenteritis

Answer 11

Vaginal Foreign Body

Question 12

Acute pelvic inflammatory disease is most effectively treated with which of the following antibiotic regimen?

a) Penicillin and gentamycin
b) Clindamycin
c) Cefoxitin and doxycycline
d) Ampicillin
e) Erythromycin

Answer 12

Foxy Doxy

Question 13

A sexually active woman presents with green foul smelling discharge. Clue cells are noted under microscopy. The best treatment for this patient would be?

a) Oral ampicillin
b) Oral septra
c) Oral tetracycline
d) Oral metronidazole
e) Vaginal metronidazole

Answer 13

d) Oral metronidazole

Question 14

A 28 yo woman who recently emigrated from Uganda comes to the physician 14 days after she noticed a painful sore in her vagina. She has no past medical or surgical histories and she has an irregular 45-day menstrual cycle. Her last menstrual period was 20 days ago. She has been sexually active with multiple partners and uses depot medroxyporgesterone. Temp is 38C. Pelvic exam shows a raw, deep, exquisite tender ulcer at the introitus, with uneven base and inflamed undermined margins.

Which of the following is most likely causal organism?

a) Treponema pallidum
b) Haemophilus ducreyi
c) Trichomonas vaginalis
d) Chlamydia trachomatis
e) Condyloma acuminata

Answer 14

Haemophilus Ducreyi (chancroid)

Question 15

A previously healthy 23 yo woman comes to the clinic c/o a bump on her vulva for 1 wk. She has been sexually active with one partner for the past 2 yrs and she uses an oral contraceptive. Examination shows multiple 0.25-cm raised, crusty papules on the posterior fourchette. A pap smear reveals low-grade squamous intraepithelial lessions.

Which of the following is the most likely diagnosis?

a) Condylomata acuminata
b) Chancroid
c) Lymphogranuloma venereum
d) Molluscum contagiosum
e) Chlamydia trachomatis infection
f) Herpes genitalis

Answer 15

a) Condylomata acuminata

Question 16

A 55 yo woman comes to clinic c/o moderate vulvar itching for 2 yrs. She is otherwise healthy, takes no meds and vital signs are within normal limits. Pelvic exam shows three 1-cm areas of white epithelium over the left labium majus. There is no inguinal adenopathy or vulvovaginal discharge.

Which of the following is the most appropriate next step in management?

a) Application of testoterone cream
b) Application of corticosteroid cream
c) Laser ablation of the affected areas
d) Punch biopsy of the affected areas
e) MRI of the pelvis
f) Cytologic examination of a lesion scraping

Answer 16

Punch Bx

Question 17

A 21 year old patient c/o a clear vaginal discharge,
which usually occurs midcycle. On examination the
vaginal pH is 4 and a wet mount and “whiff test”
are negative. Which of the following would you
expect to find on examination?

a) Vaginal condyloma
b) A “cottage cheese” like discharge in the vagina
c) A fishy odor
d) Petechiae on the vaginal mucosa and cervix (strawberry cervix)
e) The squamocolumnar junction 1 cm outside the external os (ectropion)

Answer 17

e)The squamocolumnar junction 1 cm outside the external os (ectropion)

Question 18

Which features are associated with Candida albicans overgrowth in the vagina?

a) pH<4.5
b) pH>5.0
c) “cheesy” discharge
d) “fishy” odor
e) Hyphae on potassium hydroxide wet-mount slide
f) Answers A, C and E

Answer 18

a) pH<4.5
c) “cheesy” discharge
e) Hyphae on potassium hydroxide wet-mount slide

Question 19

Which of the following is not associated with an increased risk of pelvic inflammatory disease?

a) Multiple sexual partners
b) Previous history of pelvic inflammatory disease
c) Recent intrauterine device use
d) Diabetes mellitus
e) Recent therapeutic abortion

Answer 19

DM

Question 20

Which of the following concerning Candida vulvovaginitis is false?

a) Approx 20% of women harboring Candida are asymptomatic
b) Symptoms include vaginal discharge, vulvar pruritus, burning and dyspareunia
c) Discharge has a “cottage cheese” appearance and pH of 4.5
d) All Candida specimens exhibit pseudo-hyphae in a KOH wet mount preparation
e) Monistat (miconazole nitrate) vaginal suppositories are a useful form of treatment

Answer 20

d)All Candida specimens exhibit pseudo-hyphae in

a KOH wet mount preparation

Question 21

Which of the following concerning Trichomonas vaginitis is false?

a) Metronidazole is the treatment of choice in pregnancy
b) Diagnosis is made by identifying the organism in wet mount smear
c) 25% of patients harbouring the organism are asymptomatic
d) The organism is generally transmitted by sexual intercourse
e) The vaginal pH often less than 4.5

Answer 21

e)The vaginal pH often less than 4.5

Question 22

A 42 y.o. female presents to your office with a 10 day Hx of vulvar pruritus and a thick, white vaginal discharge. She completed a course of antibiotics for a UTI, 5 days ago. The patient is a known asthmatic on inhaled betamethasone and albuterol. LMP was 23 days ago.
Vitals are normal and she is stable.
What are the differential diagnoses?

Answer 22

a) Vaginal candidiasis
b) Bacterial vaginosis
c) Trichomonas
d) PID

Question 23

Physical exam reveals vulvar erythema and edema. There is a thick, white curd-like discharge with white patches along the vaginal walls.

What Ix to do?

Answer 23

a) Vaginal pH
b) Wet mount
c) Gram stain – vagina
d) Pap smear
e) Gonococcal culture
f) Chlamydia culture
g) Urinalysis

Question 24

Lab studies show vaginal pH= 4.2 and pseudohyphae on wet mount.
What is the dx?

Answer 24

Candida

Question 25

What is the management of candida?

Answer 25

fluconazole oral

topical and vaginal Mx

Question 26

A 32-year-old married pregnant woman presents to clinic c/o a vaginal discharge. She states it has been present for the past 3 days and was associated with vulvar and vaginal itching. The discharge is thick and white. She is 14 weeks pregnant and is otherwise healthy.
What are the possible causes of her vaginal discharge?
List up to 4

Answer 26

1) Physiological discharge

2) Candida vaginitis

Question 27

Which of the following will not cause a blood tinged vaginal discharge in a 4 yr old child?

a) Sand
b) Gonococcus
c) Enterobius vermicularis
d) Sarcoma botryoides
e) Nabothian follicle

Answer 27

e)Nabothian follicle

Question 28

A 32-year-old woman comes to the physician because of recurrent painful lesions on her labia and vagina. Her first outbreak was six years ago. she has had approximately 8 -10 outbreaks each year. Each outbreak is preceded by a burning sensation in her perineal area followed by vesicles, then painful ulcers that resolve in about 10 days.

Which of the following is the most appropriate pharmacotherapy?

A. Daily oral acyclovir
B. Daily oral estrogen
C. Daily topical estrogen
D. Daily topical acyclovir
E. Daily oral penicillin

Answer 28

A)Daily oral acyclovir

Question 29

A 24 year old woman has developed the papillary
lesions shown in the illustration below. Which of
the following is the causative organism?

a) Phthirus pubis
b) Treponema pallidum
c) Molluscum contagious
d) Chlamydia trachomatis
e) Human papilloma virus

Answer 29

hpv

Question 30

A 16 year old female presents the ER with
severe vulvar burning that has increased
rapidly over the last three days. The vulvar
appearance is shown below. What is the most
likely diagnosis?

a) Candidiasis
b) Herpes genitalis
c) Behcet disease
d) Contact dermatitis
e) Condyloma accuminatum

Answer 30

Herpes

Question 31

Cyclic itching or burning of the vulvar skin
during the pre-menstrual phase of the cycle
(Cyclic vulvitis) is often caused by?

a) Bacterial vaginosis
b) Trichomonas vaginalis
c) Escherichia coli.
d) Group B streptococcus
e) Candida albicans

Answer 31

Candida Albicans