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Self-Assessment Questions

Obstetrics and Gynecology

Evaluation and Management of Vaginitis: Review Questions

Jordan G. Pritzker, MD, MBA, FACOG

Dr. Pritzker is an Assistant Professor, Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, and a practicing faculty member in the Department of Obstetrics and Gynecology, Women’s Comprehensive Health Center, Long Island Jewish Medical Center, New Hyde Park, NY.

Choose the single best answer for each question.

Questions 1 through 4 refer to the following case study.

A 21-year-old nulligravid woman visits her gynecologist for an annual examination. When questioned regarding any unusual symptoms or concerns, she reports having an intermittent thin vaginal discharge and continual vaginal irritation. She was recently treated for sinusitis with an antibiotic, although she does not recall its name. She is sexually active and is taking oral contraceptives; she and her partner do not always use condoms. She has been monogamous for the past 2 years, and recently they began practicing mutual oral sex. Her medical and surgical history is otherwise noncontributory. She states that her boyfriend has had no symptoms.

1. The patient most likely has which of the following?
  1. Normal discharge
  2. Bacterial vaginosis
  3. Candidiasis
  4. Trichomoniasis
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2. On examination, the patient’s vulva and vagina appear moderately inflamed, and she has a thin, gray, odorless, purulent discharge. She has no cervical motion tenderness. Colpitis macularis ("strawberry-like" spots on the cervix portio) are observed. Routine screening for chlamydia and gonorrhea are performed with a Papanicolaou test. Microscopic examination of a wet preparation obtained during the test shows small, flagellated organisms. Which of the following is the patient’s most likely vaginal pH?

  1. < 3.8
  2. 3.8 to 4.2
  3. 4.2 to 4.5
  4. > 4.5
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  3. Which of the following treatments for the patient’s vaginal discharge is likely to be most effective and acceptable to her?
  1. Fluconazole 150 mg taken in a single oral dose
  2. Metronidazole 2 g taken in a single oral dose
  3. Metronidazole 500 mg taken orally twice daily for 7 days
  4. Terconazole 0.8% cream (5 g) used intravaginally for 3 days
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4. The patient and her partner use the prescribed medication with good relief of symptoms. The patient is given a detailed review of the general risk factors for sexually transmitted diseases (STDs). She returns to her physician’s office 4 weeks later, reporting that her discharge has returned. On examination, Trichomonas vaginales is again found on microscopic examination of a wet preparation obtained during a Papanicolaou test. Metronidazole resistance is suspected. Which of the following is the best treatment for the patient’s condition?

  1. Clindamycin 2% cream applied for 7 consecutive nights
  2. High-dose metronidazole (750 mg to 1 g) taken orally 3 times daily for 7 days
  3. Povidone-iodine douche
  4. Topical clotrimazole suppositories used twice daily for 7 days
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5. For successful disease control efforts, many state health departments require notification by a physician or laboratory when a positive test result for an STD is recorded. In addition to AIDS, syphilis, and gonorrhea, which of the following STDs must be reported to most state health departments?

  1. Bacterial vaginosis
  2. Chlamydia
  3. Genital herpes simplex
  4. Trichomoniasis
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