Direct Examination of Vaginal Secretions

Question 1

True or false? You obtain a vaginal sample using a lubricated speculum?

Answer 1

FALSE: You obtain a vaginal sample using a NON- lubricated speculum moistened only with warm water. You can also use a sterile, polyester tipped swab on a plastic shaft or sterile wire loops.

Question 2

True or false? If you suspect N. gonnorrhorae or Trichomonas vaginalis infection, you store the sample at room temperature if not tested right away?

Answer 2

TRUE- these organism are adversely affected by fridge

Question 3

True or False: You do not refrigerate Chlamydia trachomatis or viruses?

Answer 3

False- preferred to prevent overgrowth of normal bacterial flora

Question 4

True or false? You determine the vaginal pH before placing swab into saline?

Answer 4

TRUE- use commercial pH paper

Question 5

A healthy vagina has a pH of______?

A bacterial vaginosis, trichomoniasis, or atrophic vaginitis infection has a pH of _______?

Answer 5

Healthy: 3.8-4.5
Infected: >4.5

Question 6

What is the predominant bacteria of the vagina?

Answer 6

Lactobacilli

Question 7

True or false? Blood cells are usually present in healthy vaginal secretions?

Answer 7

False- could be contamination from menstruation

Question 8

True or False? Few to several WBC are seen in healthy vaginal secretions?

Answer 8

True- Increased during ovulation and menses

Question 9

True or false? Abnormal amounts of yeast and/or hyphae/pseudphyphae is greater than or equal to 1 seen per hpf?

Answer 9

True. Normal is none or <1 seen in 10 hpfs

Question 10

You look in the microscope and see a “shaggy” appearing cell. What is it?

Answer 10

A clue cell! A squamous epithelial cell with bacteria adhering to the outside of the cell membrane.

Question 11

A clue cell is a diagnostic indicator of what??

Answer 11

Bacterial vaginosis

Question 12

True or false? Parabasal cells are not found in normal vaginal secretions and are most often found in atrophic vaginitis?

Answer 12

TRUE

Question 13

True or false? Basal cells are found in healthy vagina?

Answer 13

False

Question 14

If this organism dies, it may look like a WBC so you need to evaluate ASAP. What is it?

Answer 14

Trichomonas

Question 15

What is the most common cause of vaginal infections?

Answer 15

Bacterial vaginosis- caused by alteration of normal bacterial flora of the vagina.

Question 16

Symptoms of bacterial vaginosis:

Answer 16

Asymptomatic with only complaint of a malodorous vaginal discharge, especially after intercourse. Appearance of the discharge is gray or off-white, thin, homogenous

Question 17

Complications of Bacterial vaginosis:

Answer 17

Untreated can lead to endometritis and pelvic inflammatory disease. Pregnant women have increased risk of premature labor and LBW infants.

Question 18

Diagnosis of Bacterial Vaginosis

Answer 18

Presence of clue cells, positive amine test, pH > 4.5, homogenous vaginal discharge.

Question 19

Increased WBCs are consistent with Vaginosis or Vaginitis?

Answer 19

Vaginitis

Question 20

Recommended treatment for bacterial vaginosis is…

Answer 20

Methronidazol (oral). No concurrent treatment for sexual partners.

Question 21

True or false? Candidiasis is the second most common cause of vaginitis?

Answer 21

True

Question 22

Symptoms of candidiasis?

Answer 22

Vulvovaginal itching and soreness. External dysuria. White, curdlike discharge.

Question 23

True or false? Lab findings for Candidiasis is pH is normal (3.8-4.5), increased WBCs, budding yeast and/or pseudohyphae, squamous epi cells, lactobacilli are predominant bacterial morphotype. The amine test is negative, and KOH shows budding yeast and/or pseudohyphae.

Answer 23

TRUE

Question 24

Treatment for Candidiasis?

Answer 24

Topical antimycotic agents (miconazole, clotrimazole). Oral agents are effective also. No concurrent treatment for sexual partner.

Question 25

What is the most common gynecologic parasitic infection?

Answer 25

Trichomoniasis- STD, human is only known host!

Question 26

Symptoms of trichomoniasis?

Answer 26

50% asymptomatic, 50% severe infection. Complaints: soreness of vulvovaginal area, copius frothy, malodorous discharge that is yellowish to greenish, external dysuria and dypareunia. Exocervix may appear strawberry-like

Question 27

Lab findings of trichomoniasis?

Answer 27

Increased vaginal pH (5-6). Motile trichomonads, increased WBC, mixed bacterial flora. Amine test is positive. KOH is negative.

Question 28

Treatment for Trichomoniasis:

Answer 28

Metronidazole (Oral preferred). Concurrent treatment of sexual partner to prevent reinfection.

Question 29

Reduction of estrogen in peri- and post-menopausal females causes thinning of the vaginal epithelium and decreased glycogen production, which can lead to what?

Answer 29

Atrophic Vaginitis

Question 30

True/False? Mild to moderate cases of atrophic vaginitis are asymptomatic while rare, severe cases can cause vaginal dryness, soreness, dysparenuria, and spotting.

Answer 30

True

Question 31

True/False? In rare severe cases of atrophic vaginits, you have lots of lactobacilli and subsequent overgrowth of nonacidophillic bacteria.

Answer 31

False! In rare severe cases of atrophic vaginits, you have DISAPPEARANCE of lactobacilli and subsequent overgrowth of nonacidophillic bacteria.

Question 32

Lab Findings of Atrophic Vaginitis?

Answer 32

pH usually >5. Numerous WBCs, small amounts of RBCs, Squamous epi cells, parabasal and basal cells may also be present, lactobacilli is reduced. Amine test is negative and KOH is negative.

Question 33

Treatment of Atrophic Vaginitis?

Answer 33

Estrogen replacement- Topical vaginal ointments, oral or transcutaneous estrogen if recurrent.

Question 34

How awkward was Grant looking at this powerpoint in Paradise Cafe?

Answer 34

VERY