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Dr.Niraj Mahajan
Dr.Niraj Mahajan
Dr.Niraj Mahajan



By AdminPosted On 05-Oct-2016

1. Vaginal flora

Which of the following is the predominant bacteria in vagina during pregnancy:

a) Peptostreptococci.
b) Listeria monocytogenes.
c) Lactobacilli.
d) Streptococcus agalatia.
e) Staphylococcus.

Correct Answer: c) Lactobacilli. The primary colonizing bacteria of a healthy individual even during pregnancy are of the genus lactobacillus. Next to lactic acid production and competition for adherence, other antagonistic mechanisms of Lactobacilli consist of hydrogen peroxide (broad-spectrum antimicrobial) and bacteriocin (targetspecific antimicrobials) production.

2. Trichomonas vaginalis

a) Has eight flagella b) Has two nuclei c) Forms cysts d) Has sexual cycle completed in the cat e) Has a sucking disc
f) Has four flagella and single nucleus

Correct Answer: f)It has 4 flagella and single nucleus. It does not have cyst stage. Toxoplasma and not Trichomonas has a sexual cycle completed in the cat.

3. Clue Cells

A cervical smear report shows the presence of 'clue cells'. Otherwise the smear was reported as normal. 'Clue cells' are associated with which organisms?

a) Actinomysis
b) Candida species
c) Gardenerella vaginalis
d) Herpes genitalis
e) Human papillomavirus

Correct Answer: c) Gardenerella vaginalis (GV). Clue cells may be identified in the presence of GV. Fungal spores/hyphae may be noted with candidiasis. Human papillomavirus is associated with koilocytes. The presence of clue cells does not always indicate the need for treatment. Bacterial vaginosis is often noted in sexually active women; however, it is not sexually transmitted.

4. Bacterial Vaginosis

Which organism is not classically associated with bacterial vaginosis? a) Bacteroides species b) Gardnerella vaginalis c) Histoplasma capsulatum d) Mobiluncus species e) Mycoplasma hominisCorrect Answer: c) Histoplasma capsulatum. Histoplasma capsulatum is a fungal infection. The other four options are the classical causes of bacterial vaginosis.

5. The treatment choice for gardnerella vaginosis is

a) Ampicillin.
b) Metronidazole.
c) Clindamycin.
d) Gentamycin.
e) Vancomycin.

Correct Answer: b and c. For Gardnerella vaginalis CDC (2010) recommends treatment with metronidazole 500 mg. orally twice daily for seven days, or metronidazole gel 0.75%, one full applicator (5 g.) intravaginally, once a day for five days, or clindamycin cream 2%, one full applicator (5 g.) intravaginally at bedtime for seven days. G. vaginalis is involved, together with many other bacteria mostly anaerobic, in bacterial vaginosis. G. vaginalis is not considered the cause of the bacterial vaginosis, but a signal organism of the altered microbial ecology associated with overgrowth of many bacterial species.

6. Sexually Transmitted Disease

16-year-old female has vaginal discharge since 2 days. She also complains of dysuria. She is sexually active with one partner and uses condoms intermittently. Examination reveals some erythema of the cervix. Sexually transmitted disease testing is performed and the patient is found to have gonorrhea. While treating this patient's gonorrhea infection, treatment must also be given for which of the following?a) Bacterial vaginosis b) Chlamydia c) Herpes d) Syphilis e) TrichomoniasisCorrect Answer: b) Chlamydia. Gonorrhea should be treated with intramuscular ceftriaxone or oral cefixime, ofloxacin, or ciprofloxacin. These medications will effectively eradicate the gonococcus. However, because Chlamydia trachomatis can be isolated in up to 50% of women with gonorrhea and because women treated for gonorrhea only may soon go on to develop Chlamydia or pelvic inflammatory disease (PID). Treatment of Chlamydia is with azithromycin or doxycycline. It is also essential that this patient's partner be treated as well.

7. Milky White Discharge

Woman complaining of milky white discharge with fishy odour. No history of itching. Most likely diagnosis? a) Bacterial vaginosis b) Trichomoniasis c) Candidiasis d) Malignancy e) Urinary tract infectionCorrect Answer: a) Bacterial vaginosis (BV). The most common symptom of BV is an abnormal homogeneous off-white vaginal discharge (especially after vaginal intercourse) that may be accompanied by an unpleasant (usually fishy) smell. It is usually without significant irritation, pain, or erythema (redness), although mild itching can sometimes occur.

8. Trichomoniasis

Are there effective alternatives to imidazoles in the treatment of trichomoniasis?

a) Yes
b) No

Correct Answer: a) Yes. Nitroimidazoles (metronidazole or tinidazole) are the preferred treatment. For women who can't tolerate these treatments due to true allergy, topical paromomycin cream is an option. Patients with an immediate-type allergy to a nitroimidazole can be managed by metronidazole desensitization in consultation with a specialist (Ref: Am J Obstet Gynecol 2008;198:370–70).

9. Treatment of Trichomoniasis

What is the recommended treatment for females diagnosed with trichomoniasis?

a) Metronidazole 2 g orally in a single dose
b) Tinidazole 2 g orally in a single dose
c) Metronidazole 500 mg orally twice a day for 7 days
d) Metronidazole 400 mg orally twice a day for 7 days
e) Metronidazole 500 mg orally thrice a day for 7 days

Correct Answer: a,b,c. a and b are preferred regimens. The recommended treatments for trichomoniasis are metronidazole 2 g. orally in a single dose, or tinidazole 2 g. orally in a single dose or Metronidazole 500 mg orally twice a day for 7 days. (Ref: CDC) 

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Dr. Niraj Mahajan

MD- Gynecologist, Laparoscopic Surgeon, Uro-gynecologist , Infertility specialist & Cosmetic Gynecologist.

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