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Q: Vaginal discharge - NBME

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fongch
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04/19/07 - 11:01 AM

Before you continue: this is a question from NBME.

A 32-year-old woman comes to the physician because of vaginal discharge for 2 weeks. she has been sexually active with one female partner for 5 years. She has not been treated with antibiotics over the past 2 years. Her last Pap smear was 6 years ago when she was sexually active with a male partner. She has not used illicit drugs or alcohol. Examination shows a grayish vaginal discharge with a pH greated than 4.5. A wet mout preparatino of the vaginal discharge is most likely to show which of the following?
A. Budding yeast
B. Clue cells
C. Ferning
D. Leukocytes in sheets
E. Trichomonas vaginalis

Justice
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04/19/07 - 11:13 AM

Normal vaginal fluid has a pH between 4.0 and 4.5.
Bacterial vaginosis raises the pH above 4.5.
In candidiasis the pH of the discharge is usually less than 4.5.
Trichomoniasis discharge usually has a pH greater than 5.0

I guess the answer is (B), clue cells due to vaginosis caused by Gardnerella... Knowing about smell of the discharge would be helpful...

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fongch
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04/19/07 - 11:15 AM

I am confused between B and E.

Justice
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04/19/07 - 11:17 AM

fongch wrote:
I am confused between B and E.

I guess pH is a key... Trich would raise pH higher than 5.0...

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radonc
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04/20/07 - 03:36 AM

My answer B.

I also thought the answers were bteween B and E. But this woman is unlikely to have an STI as such, as she is a lesbian. Not likely that she has Trichomonasis (which usually gives a green-yellow discharge).
Gardnerella which causes bacterial vaginosis is not sexually transmitted, but rather the result of anaerobic overgrowth. You see clue cells on wet prep.

vradojc1
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04/20/07 - 10:22 AM

B is the most common cause of vaginal discharge

usmle12
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04/25/07 - 10:10 PM

also trichomoniasis gives u green discharge and strawberry cervix....

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