Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

YR5 Obstetrics and Gynaecology > Vaginal Discharge > Flashcards

Vaginal Discharge Flashcards

1
Q

Give 4 common causes of vaginal discharge

A

Physiological
Bacterial vaginosis
Trichomonas vaginalis
Candida

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is physiological vaginal discharge?

A

Clear/ white, mucoid.
No odour or itching.

Related to cycle (↑mid cycle + premenstrual)

A/w oestrogen (puberty, pregnancy, COCP) or sexual excitement

“Leucohorroea”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is bacterial vaginosis? Describe the discharge.

A

Elevated vaginal pH (>4.5) with Clue cells

White-grey watery offensive discharge but NO itching

Non-STI but increased risk with more sexual partners.
Unclear triggers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the cause of bacterial vaginosis?

A

Overgrowth of anaerobic bacteria, esp Gardnerella or Bacteroides, replacing usually dominant vaginal lactobacilli

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Describe the epidemiology of BV

A

Most common cause of abnormal discharge in childbearing age.

Much more prevalent in black populations (~50% vs ~10% white)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What criteria is used to diagnose BV?

A

Amsel criteria for Dx (3/4):
- white-grey homogeneous discharge
- pH >5.5
- fishy smell when KOH added
- Clue cells on microscopy wet mount

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are Clue cells?

A

Squamous epithelial cells with bacteria adherent on their walls

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What should be advised in BV?

A

Avoid vaginal douching, use of shower gel, + use of antiseptic agents or shampoo in the bath

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What investigations should be performed for bacterial vaginosis?

A

Examination + Ix can be omitted if clear dx + empirical Tx started

High vaginal swab + gram stain (ddx, recurrence)

Vaginal pH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the management for bacterial vaginosis?

A

Metronidazole 400mg BD 5-7d
or single oral dose 2g
or
PV Clindamycin/ metronidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the management of BV in pregnancy?

A

Metronidazole 400mg BD 5-7d

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What complications are associated with bacterial vaginosis?

A

BV can (rarely) cause problems in pregnancy:

Miscarriage

Preterm labour

LBW

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Describe the discharge and symptoms in candidiasis

A

White curd-like discharge “cottage cheese”
Vulval itching++
Soreness
No odour.
May have excoriations + erythema +/- satellite lesions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the epidemiology of candidiasis?

A

Non-sexually transmitted.

75% lifetime risk

Very common in pregnancy

Unlikely in post-menopausal patients unless diabetic, immunosuppressed, or have recently had Abx.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the oral management for candidiasis?

A

Itraconazole 200mg PO BD for 1 day
or
Fluconazole 150mg PO stat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the local management of candidiasis? For which patients is this the only option?

A

Clotrimazole pessary/ cream

Topical for 12-15y

Intravaginal Pregnant women

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What should be prescribed if vulval symptoms are present in candidiasis?

A

Topical imidazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What treatment can be bought OTC for candidiasis?

A

Intravaginal clotrimazole (Canesten)
Topical clotrimazole
Oral fluconazole

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What advice should be given in candidiasis?

A

Return if not resolved in 7-14d
Don’t over-clean, use soaps/ feminine hygiene products, douche, wear tight fitting underwear

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

When is candidiasis considered to be recurrent? How is this managed?

A

> ,4x per year
Induction: Fluconazole every 3/7 x 3
Maintenance: Fluconazole weekly 6/12

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Give 7 risk factors for candidiasis

A

Pregnancy
OCPs
Diabetes
Immunosuppression
Recent Abx use
Steroids
Excessive washing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What are 6 signs and symptoms of Trichomonas vaginalis?

A

Green/grey frothy fishy-smelling discharge
Itching
Soreness
Dysuria
Dyspareunia/ bleeding after SI
2% also have ‘strawberry cervix’ (petechiae)

23
Q

What causes TV?

A

Sexually transmitted flagellated protozoan

some evidence it may enhance HIV transmission

24
Q

What investigations are performed for TV?

A

Refer to GUM
Microscopy of wet mount: motile trophozoites
High vaginal swab + NAAT
STI screen

25
Q

What is the management of TV?

A

Metronidazole 2g PO STAT
OR
Metronidazole 400–500mg BD 5–7d

26
Q

What is the management of TV in pregnant or breastfeeding women?

A

Metronidazole 400–500mg BD 5–7d

27
Q

What are 4 signs and symptoms of cervicitis?

A

Greenish mucopurulent watery discharge
No odour
No itch
Cervix inflamed + may bleed easily

Can also have PCB, IMB, dysuria, deep dyspareunia, deep pelvic pain (PID)

28
Q

What is cervicitis most commonly caused by?

A

STI - most commonly chlamydia or gonorrhoea
(70% chlamydia = asymptomatic + most gonorrhoea is asymptomatic too)

29
Q

How should cervicitis be managed?

A

Treat as for chlamydia whilst awaiting swab results:
Azithromycin PO STAT
or
Doxycycline BD 7d

Azithromycin 1g PO stat if pregnant

Refer for contact tracing

30
Q

Give 3 signs/ symptoms of discharge caused by foreign body

A

Grey/ bloody purulent discharge
Offensive smell
Not itchy

31
Q

What is management for foreign body?

A

Remove

32
Q

Give 3 signs/ symptoms of discharge caused by malignancy

A

Bloody watery discharge
Offensive smell
No itch

33
Q

How should discharge caused by possible malignancy be managed?

A

High index of suspicion in any post-menopausal with ↑PV discharge
Urgent ref 2ww + imaging

34
Q

Give 3 signs/ symptoms of atrophic vaginitis

A

Clear/ blood stained watery discharge
No odour.
Can have itching, soreness, dyspareunia

35
Q

Give 3 risk factors for atrophic vaginitis

A

Post-menopausal
Hormone blockers e.g. Tamoxifen
Lactating

36
Q

What is management of atrophic vaginitis?

A

topical oestrogen

37
Q

Give 4 signs/ symptoms of cervical ectropion

A

Clear watery discharge
No odour
No itch
+/- PCB, PMB, IMB

38
Q

How else may cervical ectropion present?

A

asymptomatic + picked up on routine smear test

39
Q

Which 2 groups are more likely to develop cervical ectropion?

A

OCP
Pregnancy

40
Q

What is management of cervical ectropion?

A

N/A if asymptomatic
If symptomatic stop COCP or
Cryotherapy

41
Q

What is cervical ectropion?

A

presence of everted endocervical columnar epithelium on the ectocervix

42
Q

What is the most common cause of vaginal discharge and soreness in childhood?

A

Vulvovagintis
often occurring when starts being responsible for toileting

43
Q

What is the management of vulvovaginitis?

A

Often no organism isolated

Wipe front to back
Avoid bubble bath + bio washing powder
Loose cotton underwear.

Can consider simple emollient or short course oestrogen cream

44
Q

What signs and symptoms could indicate fistula is causing PV discharge?

A

Hx of recurrent infections, faecal / urinary incontinence

Often secondary to obstructed/ prolonged delivery

45
Q

How should a patient be investigated for fistulae? What is the management?

A

Sims speculum
(unlikely to see on Cusco)

Surgical repair

46
Q

What investigations should be used for PV discharge?

A

Vaginal pH
Endocervical/ self-taken vulvovaginal swab for NAAT
High vaginal swab
Urine pregnancy test
Urine dip

47
Q

What is indicated by vaginal pH < 4.5?

A

Candidiasis

48
Q

What is normal vaginal pH?

A

3.5-4.5

49
Q

What is indicated by vaginal pH > 4.5?

A

BV
TV

50
Q

What is a endocervical/ self taken vulvovaginal swab used to screen for?

A

Chlamydia
Gonorrhoea

51
Q

What is a high vaginal swab used to screen for?

A

BV
Candida
TV

52
Q

Which causes of PV discharge should be referred to GUM?

A

Chlamydia
Gonorrhoea
TV

53
Q

If testing for gonorrhoea or chlamydia, what else should be offered?

A

blood tests for HIV + syphilis

YR5 Obstetrics and Gynaecology (73 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions