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Vaginal Dc Flashcards

1
Q

Vaginal discharge is a common presentation of

those STIs responsible for_______

A

PID.

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2
Q

The first step in diagnosis is to determine if the

discharge is _____ or ______

A

cervical or vaginal in origin

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3
Q

One of the simplest methods of making a proper

diagnosis is a ________

A

wet film examination

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4
Q

The two most common causes of vaginal discharge

are _______ and ________

A

physiological discharge and infective vaginitis.

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

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

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6
Q

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

A

lactobacilli,

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7
Q

Other commensal bacteria in vaginal dc include

1
2
3

A

staphylococci, diphtheroids and streptococci

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8
Q

T or F

With physiological discharge there is usually no
odour or pruritus.

A

T

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9
Q

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

A 
bacterial vaginosis (formerly bacterial vaginitis,
Gardnerella vaginalis or Haemophilus vaginalis )
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10
Q

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

A

Candida albicans

Trichomonas vaginalis

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11
Q

_______ infection of

vaginal epithelium may cause excess discharge

A

Human papilloma virus

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12
Q

________ of the cervix or vaginal vault may

cause a bloody or brownish discharge

A

Endometriosis

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13
Q

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

A

endocervix

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14
Q

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

A

Candida

Trichomonas

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15
Q

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

A

Acetic acid 2%

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16
Q

_______add a drop of 10% KOH to

vaginal secretions smeared on glass slide

A

Amine or ‘whiff’ test

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17
Q

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

A

3 months of age.

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18
Q

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

A

Vulvovaginitis

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19
Q

Tx of vulvovaginitis

A

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

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20
Q

Vaginal candidaiasis

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

A

C. glabrata (in particular),

C. parapsilosis and C. tropicalis

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21
Q

SSx of Vaginal candidaiasis

A
  • 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
22
Q

Factors predisposing to vaginal
candidiasis

Endogenous
1
2
3
4
A
  • Diabetes mellitus
  • AIDS syndrome
  • Pregnancy
  • Debilitating diseases
23
Q

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

A

1–7 days

24
Q

________ is best reserved for recurrent cases or

if there is local reaction to the azoles

A

Nystatin

25
Q

______ (0.5% aqueous solution) is useful

for rapid relief, if available

A

Gentian violet

26
Q

Recommended initial regimen for vaginal candida

A

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)

27
Q

An alternative regimen, especially for recurrent

infections with vaginal candida

A

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

28
Q

If patient intolerant of vaginal therapy, use

_______

A

fluconazole 150 mg (o) as a single dose

29
Q 
Recalcitrant cases (proven by microscopy
and if not pregnant) or recurrent and
chronic cases
A

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

30
Q

The time to achieve remission for vaginal candidiasis varies from _______

A

2 weeks to 6 months

31
Q

T or F

vaginal candida

A male sexual partner does not usually
require treatment

A

T

32
Q

How to Tx male partner if with candida

A

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

33
Q

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

A

Toruloposis glabrata

34
Q

In preparing for the antifungal preparation,

use_______

A

1–3% acetic acid or sodium bicarbonate

solution (1 tablespoon to 1 litre of water).

35
Q

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

A

Trichomonas vaginalis

36
Q

Ssx of trichomonas vaginalis

A

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

37
Q

Appearance of cervix in trichomonas

A
  • Diffuse erythema of cervix and vaginal walls

* Characteristic punctate appearance on cervix

38
Q

Tx of trichomonas?

A

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

39
Q

Tx of Trichomonas

T or F

• The sexual partner, whether male or female,
must be treated simultaneously

A

T

40
Q

Tx of Trichomonas

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

A

3–5 day

41
Q

_______ 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.

A

Bacterial vaginosis

42
Q

Findings on Amine Whiff Test for BV

A

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

43
Q

Tx of BV

A

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

44
Q

____________ can be used for resistant infections

or during pregnancy

A

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

clindamycin cream

45
Q

__________ 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

A

Group B Streptococcus ( S. agalactiae )

46
Q

GBS

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

A

benzylpenicillin 1.2 g IV stat, then 600 mg IV

4 hourly until delivery

47
Q

GBS

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

A

500 mg (o) tds for 7 days

48
Q

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

A

A retained tampon,

49
Q

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

A

Tampon toxic shock syndrome:

staphylococcal infection

50
Q

SSx of Tampon toxic shock syndrome:

staphylococcal infection

A

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

MC (90 decks)

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