Vaginal Fluid

Question 1

one of the most common conditions diagnosed by health-care providers for female patients, particularly women of childbearing age

Answer 1

Vaginitis

Question 2

Microscopic methods include a _

Answer 2

saline wet mount examination, potassium hydroxide (KOH) examination

Question 3

gold standard exam for vaginal secretion

Answer 3

Gram stain

Question 4

protein to diagnose ruptured fetal membranes, or fetal fibronectin enzyme to assess the risk of preterm delivery

Answer 4

placental a1-microglobulin (PAMG-1)

Question 5

for specimen collection, may contain antibacterial agents and must not be used

Answer 5

lubricants

Question 6

The specimen is collected by swabbing the _ to collect epithelial cells along with the vaginal secretions using one or more sterile, _on a plastic shaft or swabs specifically designated by the manufacturer.

Answer 6

vaginal walls and vaginal pool

;polyester-tipped swabs

Question 7

Cotton swabs should not be used because cotton is toxic to

Answer 7

Neisseria gonorrhoeae,

Question 8

the wood in a wooden shaft may be toxic to

Answer 8

Chlamydia trachomatis

Question 9

calcium alginate can inactivate _ for viral cultures

Answer 9

herpes simplex virus (HSV)

Question 10

The health-care provider performs a gross examination of the vaginal secretions and then places the swab in a tube containing _ of sterile physiologic saline

Answer 10

0.5 to 1.0 mL

Question 11

Thin, homogeneous, white- to-gray vaginal discharge

Answer 11

bacterial vaginosis

Question 12

White, curd-like vaginal discharge

“cottage-cheese like”

Answer 12

candidiasis

Question 13

Yellow-green frothy adherent vaginal discharge increased in volume

Answer 13

trichomoniasis

Question 14

Excessive purulent vaginal discharge, vaginal erythema

Answer 14

desquamative inflammatory vaginitis

atrophic vaginitis

Question 15

candidiasis has pH of

Answer 15

3.8 - 4.5

Question 16

bacterial vaginosis has _ clue cells

Answer 16

> 20%

Question 17

Large clumps of epithelial cells are present in

Answer 17

candidiasis

Question 18

Occasional parabasal or basal cells

> 1+ RBCs

Answer 18

desquamative inflammatory vaginitis

atrophic vaginitis

Question 19

Budding yeast cells and pseudohyphae can be seen in

Answer 19

candidiasis

Question 20

2+ gram- positive cocci

Answer 20

desquamative inflammatory vaginitis

Question 21

positive in amine test (whiff)

Answer 21

bacterial vaginosis

trichomoniasis

Question 22

Specimens must be kept at room temperature to preserve the motility of _ and the recovery of _

Answer 22

Trichomonas vaginalis; N. gonorrhoeae

Question 23

Specimens for T. vaginalis should be examined within _ hours of collection

Answer 23

2

Question 24

_ and _ must be refrigerated to prevent overgrowth of normal flora

Answer 24

C. trachomatis and herpes simplex virus

Question 25

normal vaginal flora includes a predominance of large, rod-shaped, gram-positive _ and _

Answer 25

lactobacilli; squamous epithelial cells

Question 26

t/f. wbc and rbc may be present if px if menstruating

Answer 26

true

Question 27

normal appearance of vaginal secretions

Answer 27

White, flocculent discharge

Question 28

normal pH of vaginal secretions

Answer 28

3.8 - 4.2

Question 29

normal amine (whiff) test of vaginal secretions

Answer 29

neg

Question 30

normal wbcs of vaginal secretions

Answer 30

2+

Question 31

normal lactobacilli of vaginal secretions

Answer 31

predominant

Question 32

normal clue cells of vaginal secretions

Answer 32

absent

Question 33

lactobacilli produces the end product _ from glycogen metabolism. _ provides an acidic vaginal environment with a pH value between 3.8 and 4.5

Answer 33

lactic acid

Question 34

Some lactobacilli subgroups also produce _, which is toxic to pathogens, and helps keep the vaginal pH acidic to provide protection from urogenital infections. _ has been associated with the absence of hydrogen peroxide–producing lactobacilli

Answer 34

hydrogen peroxide Bacterial vaginosis

Question 35

_ production also is necessary to preserve an acidic vaginal environment

Answer 35

estrogen

Question 36

used as a confirmatory examination for yeast or bacterial vaginosis

Answer 36

gram stain

Question 37

Less than 10 organisms or cells/slide

Answer 37

rare

Question 38

6 to 30 organisms or cells/hpf

Answer 38

3+

Question 39

a polygonal “flagstone” appearance. They contain a prominent centrally located nucleus about the size of a red blood cell and a large amount of irregular cytoplasm, lacking granularity, with distinct cell margins

Answer 39

Squamous epithelial cells 25-70 μm

Question 40

abnormal variation of the squamous epithelial cell; granular, irregular appearance sometimes described as “shaggy.”

Answer 40

clue cells

Question 41

diagnostic of bacterial vaginosis caused by G. vaginalis

Answer 41

clue cells

Question 42

rbc in diameter | wbc in diameter

Answer 42

7-8 um | 14-16 um

Question 43

RBCs can be confused with yeast cells and are distinguished from yeast cells by _, which will lyse the RBCs but allow the yeast cells to remain intact.

Answer 43

KOH

Question 44

marked basophilic granulation or amorphic basophilic structures (“blue blobs”) in the surrounding cytoplasm

Answer 44

parabasal cells 16-40 um

Question 45

located deep in the basal layer of the vaginal stratified epithelium

Answer 45

basal cells 10-16 um

Question 46

appear as large gram-positive, nonmotile rods on Gram stain and produce lactic acid, which maintains the vaginal pH at 3.8 to 4.5

Answer 46

Lactobacillus spp.

Question 47

t/f.

Answer 47

Other bac- teria commonly present include anaerobic streptococci, diph- theroids, coagulase-negative staphylococci, and a-hemolytic streptococci.

Question 48

atrial flagellated protozoan that can cause vaginal inflammation and infection in women. The organism is oval shaped, measures 5 to 18 μm in diameter, and has four anterior flagella and an undulating membrane that extends half the length of the body

Answer 48

Trichomonas vaginalis

Question 49

Trichomonas vaginalis motion

Answer 49

jerky

Question 50

cause most fungal infections

Answer 50

Candida albicans and non–Candida spp.

Question 51

yeast appear as both:

Answer 51

- budding yeast cells (blastophores) | - hyphae

Question 52

multiple buds that do not detach and form chains, can also be seen

Answer 52

pseudohyphae

Question 53

t/f. Lactobacillus acidophilus (large gram-positive rods), G. vaginalis and Bacteroides spp. (small gram-variable or gram- negative rods), and Mobiluncus spp. (curved gram-variable rods).

Answer 53

true

Question 54

gold standard test for detecting yeast and Trichomonas

Answer 54

culture

Question 55

Special media called _ is required for T. vaginalis.

Answer 55

Diamond’s medium

Question 56

developed to specifically identify the causative pathogen for vaginitis

Answer 56

DNA hybridization probe methods

Question 57

dna testing is easy to perform and results are available in _ hour with a sensitivity of 95%

Answer 57

1

Question 58

affecting 40% to 50% of women of childbearing age.1 BV occurs when there is an imbalance in the ratio of normal vaginal bacterial flora

Answer 58

bacterial vaginosis

Question 59

Patients may present with a “straw- berry cervix” because of punctuate hemorrhages.

Answer 59

Trichomoniasis

Question 60

Trichomoniasis is classified as an STI, frequently occurs with _, and has been associated with enhanced transmission rates of _.

Answer 60

gonorrhea and Chlamydia infections; HIV

Question 61

syndrome found in postmenopausal women. This syndrome is caused by thinning of the vaginal mucosa because of reduced estrogen production and decreased glycogen production.

Answer 61

Atrophic Vaginitis