Vaginal Discharge

Question 1

What key history would you obtain from a patient who complains of vaginal discharge?

Answer 1

Amount
Color
Consistency
Odor
Duration
Associated vaginal burning, pain, or pruritus
Recent sexual activity
Onset of LMP
Use of contraceptives, tampons and douches
History of similar symptoms
History of STDs

Question 2

What key physical exams would you perform on a patient who complains of vaginal discharge?

Answer 2

Vital signs
Abdominal exam
Complete pelvic exam

Question 3

28 yo F presents with a thin, grayish-white, foul-smelling vaginal discharge. Differentials?

Answer 3

Bacterial vaginosis
Vaginitis - candidal
Vaginitis - trichomonal
Cervicitis - chlamydia, gonorrhea

Question 4

28 yo F presents with a thin grayish-white, foul-smelling vaginal discharge. Differentials: bacterial vaginosis, vaginitis (candidal), vaginitis (trichomonal), cervicitis (chlamydia, gonorrhea). Workup

Answer 4

Pelvic exam
Wet mount
Cervical cultures
KOH prep ("whiff test")
pH of vaginal fluid

Question 5

30 yo F presents with thick, white cottage cheese-like, odorless vaginal discharge and vaginal itching. Differentials?

Answer 5

Vaginitis - candidal
Bacterial vaginosis
Vaginitis - trichomonal

Question 6

30 yo F presents with thick, white cottage cheese-like, odorless vaginal discharge and vaginal itching. Differentials: vaginitis (candidal), bacterial vaginosis, vaginitis (trichomonal). Workup?

Answer 6

Pelvic exam
KOH prep ("whiff test")
Wet mount
Cervical cultures
pH of vaginal fluid

Question 7

35 yo F presents with malodorous profuse, frothy greenish vaginal discharge with intense vaginal itching and discomfort. Differentials?

Answer 7

Vaginitis - trichomonal
Vaginitis - candidal
Bacterial vaginosis
Cervicitis (chlamydia, gonorrhea)

Question 8

35 yo F presents with malodorous profuse, frothy greenish vaginal discharge with intense vaginal itching and discomfort. Differentials: vaginitis (trichomonal), vaginitis (candidal), bacterial vaginosis, cervicitis (chlamydia, gonorrhea). Workup?

Answer 8

Pelvic exam
Wet mount
Cervical cultures
pH of vaginal fluid
KOH prep ("whiff test")