Rx Flashcards
A 21-year-old sexually active woman presents to the physician with a history of pain on urination and a malodorous, green vaginal discharge. She is treated with a one-time dose of metronidazole.
Which of the following was likely seen on microscopic examination of the patient’s discharge to confirm her diagnosis?
A. Bacteria-covered epithelial cells B. Budding yeast with pseudohyphae C. Multinucleated giant cells D. Squamous cell dysplasia E. Trophozoites
The correct answer is E.
This woman is presenting with a classic case of trichomoniasis, which accounts for 10% of cases of women who seek treatment for a sexually transmitted disease. It is characterized by vaginal itching, burning on urination, and a foul-smelling green discharge. Diagnosis is confirmed by the presence of flagellated trophozoites on a wet mount of the discharge. Treatment consists of a one-time dose of metronidazole for the patient and her sexual partner.
WHY NOT?
A - Bacteria-covered epithelial cells or “clue cells” are recognized by their granular look and fuzzy borders. They are characteristic of bacterial vaginosis, which is the most common cause of vaginitis. Symptoms typically include off-white, nonpurulent discharge as well as a fishy odor that is especially present after sexual intercourse. It is treated with a course of metronidazole.
B - Budding yeast with pseudohyphae are typically seen on a potassium hydroxide preparation of an infection caused by Candida albicans. Virtually every woman’s vagina is colonized with Candida; however, in certain circumstances such as antibiotic use, the organism gains competitive advantage and is able to proliferate. Candidal infections typically present with vaginal itching and a white, “cheesy” discharge. They are extremely common and affect a majority of premenopausal women. Treatment is a topical antifungal cream or an oral antifungal such as fluconazole.
C - Multinucleated giant cells are observed on Tzanck smear of active genital herpes simplex virus (HSV) lesions. This test, however, has a low sensitivity and specificity, and viral culture from debrided lesions is preferred. Genital herpes infections are usually caused by HSV type 2 and symptoms include painful vulvar or cervical lesions that are occasionally accompanied by systemic symptoms such as fever, headache, and myalgia. Although HSV type 2 cannot be cured, symptomatic treatment is available with antiviral agents such as acyclovir.
D - Squamous cell dysplasia is an abnormal proliferation of cervical cells often detectable on Pap smears. It is caused by human papillomavirus infection. It would not cause an abnormal discharge, itching, or burning symptoms.
Bottom Line:
Trichomoniasis, a sexually transmitted disease characterized by vaginal itching, burning on urination, and foul-smelling green discharge, is diagnosed by the presence of trophozoites on a wet mount of the vaginal discharge.
How are norepinephrine-secreting cells distinguished from epinephrine-secreting cells in the adrenal medulla/
NE secreting cells have dense core granules and have a more strongly positive chromaffin reaction.
Chromaffin cells are found where, secrete what, and are derived from what?
- Found in Adrenal medulla (below zona reticularis)
- Secrete epinephrine, norepinephrine, and enkephalin
- Derived from embryonic neural crest cells
- These cells have large nuclei and are strongly basophilic. They have little endoplasmic reticulum and store NO lipids.
Where is aldosterone secreted from in the adrenal gland?
Aldosterone is secreted by zona glomerulosa cells (round, strongly stained nuclei, and are found below the adrenal capsule, arranged in irregular ovoid clusters)
Where are androgens secreted from?
Zona reticularis (innermost zone of the adrenal cortex) comprised of an irregular network of branching cords and clusters of cells with a few lipid droplets and hematoxylin and eosin stains reveal the brown pigment LIPOFUSCIN
Where is cortisol secreted from?
Cortisol is secreted from the Zona Fasciculata in the adrenal cortex. This zone is the middle and the broadest of the three cortical zones. It is identified histologically by radially arranged cords of single cell width. These cells have abundant poorly staining cytoplasm and are rich in mitochondria and lipid droplets.
What is the order of layers of the adrenal cortex (from outside to inner layer)?
1) Zona Glomerulosa
2) Zona Fasciculata
3) Zona Reticularis
GFR = Salt (Na = aldosterone), Sugar (glucocorticoids), and Sex (sex androgens)
“The deeper you go, the sweeter it gets”
Herniation of a disc is more likely to affect the upper or lower nerve root (ie L5-S1 herniated disc effects which?)
Lower –> S1
