Vaginal Dc

Question 1

Vaginal discharge is a common presentation of

those STIs responsible for_______

Answer 1

PID.

Question 2

The first step in diagnosis is to determine if the

discharge is _____ or ______

Answer 2

cervical or vaginal in origin

Question 3

One of the simplest methods of making a proper

diagnosis is a ________

Answer 3

wet film examination

Question 4

The two most common causes of vaginal discharge

are _______ and ________

Answer 4

physiological discharge and infective vaginitis.

Question 5

Normal physiological discharge is usually milky-white
or clear mucoid and originates from a combination of
the following sources:
1
2
3
4
5

Answer 5

• cervical mucus (secretions from cervical glands)
• vaginal secretion (transudate through vaginal
mucosa)
• vaginal squamous epithelial cells (desquamation)
• cervical columnar epithelial cells
• resident commensal bacteria

Question 6

The predominant bacterial flora in vaginal dc are _________ which produce lactic acid from glucose derived from the epithelial cells

Answer 6

lactobacilli,

Question 7

Other commensal bacteria in vaginal dc include

1
2
3

Answer 7

staphylococci, diphtheroids and streptococci

Question 8

T or F

With physiological discharge there is usually no
odour or pruritus.

Answer 8

T

Question 9

The commonest cause of infective vaginitis is
______________ which
accounts for 40–50% of cases of vaginitis

Answer 9

bacterial vaginosis (formerly bacterial vaginitis,
Gardnerella vaginalis or Haemophilus vaginalis )

Question 10

________ is the causative agent in 20–30% of cases
while ________causes about 20% of cases
in Australia.

Answer 10

Candida albicans

Trichomonas vaginalis

Question 11

_______ infection of

vaginal epithelium may cause excess discharge

Answer 11

Human papilloma virus

Question 12

________ of the cervix or vaginal vault may

cause a bloody or brownish discharge

Answer 12

Endometriosis

Question 13

A mucopurulent discharge appearing from the________may be the clue to an STI such as Chlamydia and gonorrhoea

Answer 13

endocervix

Question 14

_______ infection may not show the characteristic
curds, ‘the strawberry vagina’ of ________ is
uncommon and bubbles may not be seen.

Answer 14

Candida

Trichomonas

Question 15

___________ is useful in removing the discharge
and mucus to enable a clearer view of the cervix and
vaginal walls

Answer 15

Acetic acid 2%

Question 16

_______add a drop of 10% KOH to

vaginal secretions smeared on glass slide

Answer 16

Amine or ‘whiff’ test

Question 17

Most newborn girls have some mucoid white vaginal
discharge. This is normal and usually disappears by
________

Answer 17

3 months of age.

Question 18

_________ is the most common gynaecological
disorder of childhood, the most common cause being
a non-specific bacterial infection

Answer 18

Vulvovaginitis

Question 19

Tx of vulvovaginitis

Answer 19

local oestrogen cream or tablet (e.g. Vagifem).
The tablet is preferred as it is less messy
or
zinc and castor oil soothing cream

Question 20

Vaginal candidaiasis

with the widespread use
of over-the-counter antifungals, resistant nonalbicans
species, such as________, ______ and ______ are becoming more
common

Answer 20

C. glabrata (in particular),

C. parapsilosis and C. tropicalis

Question 21

SSx of Vaginal candidaiasis

Answer 21

• Intense vaginal and vulval pruritus
• Vulval soreness
• Vulvovaginal erythema (brick red)
• Vaginal excoriation and oedema
• White, curd-like discharge (see FIG. 106.3 )
• Discomfort with coitus
• Dysuria

Question 22

Factors predisposing to vaginal
candidiasis

Endogenous
1
2
3
4

Answer 22

• Diabetes mellitus
• AIDS syndrome
• Pregnancy
• Debilitating diseases

Question 23

For the first attack of candidiasis it is appropriate
to select one of the range of vaginal azoles therapies
(clotrimazole, butoconazole, miconazole) for_____

Answer 23

1–7 days

Question 24

________ is best reserved for recurrent cases or

if there is local reaction to the azoles

Answer 24

Nystatin

Question 25

______ (0.5% aqueous solution) is useful | for rapid relief, if available

Answer 25

Gentian violet

Question 26

Recommended initial regimen for vaginal candida

Answer 26

clotrimazole 500 mg vaginal tablet as a single dose or 100 mg for 6 nights ± clotrimazole 2% cream applied to vulvovaginal and perineal areas 8–12 hourly (for symptomatic relief)

Question 27

An alternative regimen, especially for recurrent | infections with vaginal candida

Answer 27

nystatin pessaries twice daily for 7 days and/or nystatin vaginal cream (100 000 U per 5 g) twice daily for 7 days

Question 28

If patient intolerant of vaginal therapy, use | _______

Answer 28

fluconazole 150 mg (o) as a single dose

Question 29

``` Recalcitrant cases (proven by microscopy and if not pregnant) or recurrent and chronic cases ```

Answer 29

fluconazole 50 mg (o) once daily or itraconazole 100 mg (o) once daily

Question 30

The time to achieve remission for vaginal candidiasis varies from _______

Answer 30

2 weeks to 6 months

Question 31

T or F vaginal candida A male sexual partner does not usually require treatment

Answer 31

T

Question 32

How to Tx male partner if with candida

Answer 32

If symptomatic (usually balanitis in an uncircumcised male), treat with clotrimazole 1% + hydrocortisone 1% topically, 12 hourly until 2 weeks after symptoms resolve

Question 33

________ is the commonest non-albicans species, which exhibit reduced susceptibility to azoles.

Answer 33

Toruloposis glabrata

Question 34

In preparing for the antifungal preparation, | use_______

Answer 34

1–3% acetic acid or sodium bicarbonate | solution (1 tablespoon to 1 litre of water).

Question 35

This flagellated protozoan, which is thought to originate in the bowel, infects the vagina, Skene's ducts and lower urinary tract in women and the lower genitourinary tract in men

Answer 35

Trichomonas vaginalis

Question 36

Ssx of trichomonas vaginalis

Answer 36

Profuse, thin discharge (grey to yellow–green in colour) • Small bubbles may be seen in 20–30% • Pruritus

Question 37

Appearance of cervix in trichomonas

Answer 37

* Diffuse erythema of cervix and vaginal walls | * Characteristic punctate appearance on cervix

Question 38

Tx of trichomonas?

Answer 38

oral metronidazole 2 g as a single dose (preferable) or 400 mg bd for 5 days (if relapse) or tinidazole 2 g as a single dose

Question 39

Tx of Trichomonas T or F • The sexual partner, whether male or female, must be treated simultaneously

Answer 39

T

Question 40

Tx of Trichomonas For resistant infections a ______ course of either metronidazole or tinidazole may be necessary

Answer 40

3–5 day

Question 41

_______ is a clinical entity of mixed aetiology characterised by the replacement of the normal vaginal microflora (chiefly Lactobacillus ) with a mixed flora consisting of Gardnerella vaginalis, other anaerobes such as Mobiluncus species, and Mycoplasma hominis. This accounts for the alkalinity of the vaginal pH.

Answer 41

Bacterial vaginosis

Question 42

Findings on Amine Whiff Test for BV

Answer 42

• Liberates an amine-like, fishy odour on admixture of 10% KOH (the amine whiff test) • Clue cells

Question 43

Tx of BV

Answer 43

metronidazole 400 mg (o) bd for 7 days (or 2 g stat) or 0.75% vaginal gel applied at bedtime for 5 days

Question 44

____________ can be used for resistant infections | or during pregnancy

Answer 44

Clindamycin 300 mg (o) bd for 7 days or 2% | clindamycin cream

Question 45

__________ is a commensal in up to 40% of healthy humans. It is a problem if detected in the pregnant woman because of serious infection in the neonate

Answer 45

Group B Streptococcus ( S. agalactiae )

Question 46

GBS Tx In certain at-risk circumstances, such as premature rupture of the membranes or a previous infected neonate

Answer 46

benzylpenicillin 1.2 g IV stat, then 600 mg IV | 4 hourly until delivery

Question 47

GBS In the non-pregnant woman give amoxycillin ____________ if there is significant pyogenic infection

Answer 47

500 mg (o) tds for 7 days

Question 48

________which may be impacted and cannot be removed by the patient, is usually associated with an extremely offensive vaginal discharge

Answer 48

A retained tampon,

Question 49

This rare, dramatic condition is caused by the production of staphylococcal exotoxin associated with tampon use for menstrual protection. The syndrome usually begins within 5 days of the onset of the period

Answer 49

Tampon toxic shock syndrome: | staphylococcal infection

Question 50

SSx of Tampon toxic shock syndrome: | staphylococcal infection

Answer 50

The clinical features include sudden onset fever, vomiting and diarrhoea, muscle aches and pains, skin erythema, hypotension progressing to confusion, stupor and sometimes death