Author Question: A 23-year-old female complains of a white-yellow vaginal discharge with a fishy odor for the last 2 ... (Read 97 times)

Caiter2013 · **on:** Jun 25, 2018

A 23-year-old female complains of a white-yellow vaginal discharge with a fishy odor for the last 2 days. A wet prep shows characteristic clue cells (epithelial cells embedded with bacteria). These findings are indicative of:

A. Chlamydia infection
B. Bacterial vaginosis
C. Vaginal candida
D. Gonorrhea

Question 2

A 33-year-old female patient complains of white, thick vaginal discharge and severe pruritus of the outer genitalia. On pelvic exam, the vaginal introitus is red and swollen with a thin layer of white exudate.

The bimanual exam is normal. A KOH prep is positive for hyphae. These findings are indicative of:
A. Vaginal candidiasis
B. Trichomonas infection
C. Chlamydia
D. Bacterial vaginosis

mcomstock09 · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

ANS: B
Gardnerella vaginalis causes bacterial vaginosis, the most prevalent vaginal infection. Of those women who are symptomatic, the overwhelming complaint is of a malodorous discharge. The odor of G. vaginalis is a distinct, fishy odor. The odor is usually noticeable during the pelvic examination, but a few drops of 10 KOH solution on the wet prep slide augments the odor. The discharge is fairly thick and white. Patients do not complain of itching, and, generally, there is no inflammation of the vaginal mucosa. Microscopically, the wet prep shows the characteristic clue cells (epithelial cells embedded with bacteria).

Answer to Question 2

ANS: A
The discharge associated with yeast vaginitis can be differentiated from other infections by symptomatology and wet prep examination. The discharge is very thick, curdlike, and adheres to the vaginal walls. Intense vulvar itching accompanies the discharge. In most cases, inflammation and swelling around the labia and introitus occur. A high suspicion of yeast can be made on physical examination with a wet prep to confirm the diagnosis of Candida albicans. A 10 KOH (potassium hydroxide) prep is most helpful for visualizing budding yeast and hyphae microscopically.