Vulvovaginitis — MCQs
Which of the following conditions is associated with the detection of clue cells on microscopy?
Senile vaginitis is due to :
A 27-year-old woman presented with a malodorous discharge in the vagina which started a week earlier. On examination, Whiff's test is positive and the gram stain shows the presence of clue cells. This infection is commonly treated with which of the following?
A pregnant female presents with active herpetic lesions on the vulva. What is the most appropriate management?
A 25 year old lady presented with curdy white discharge from the vagina is likely to be suffering from:-
A 25-year-old woman presents with thin, gray-white vaginal discharge and mild itching. Microscopy shows clue cells and pH is 5.5. What is the most appropriate treatment?
A 23-year-old woman presents with vulvovaginal itching, burning, and thick white discharge. Microscopy shows budding yeast with pseudohyphae. She reports recurrent episodes. What is the most appropriate management?
A 25-year-old woman presents with vaginal discharge and vulvovaginal irritation. Wet mount shows motile trichomonads. She mentions having a similar infection 2 months ago treated with single-dose metronidazole. What is the most likely explanation for her current infection?
Which of the following are Amsel's diagnostic criteria? I. Vaginal pH>4.5 II. Positive Whiff test III. Presence of clue cells >20 % IV. Positive bacterial vaginal culture Select the correct answer using the code given below :
A 26-year-old woman presents with vaginal discharge and dyspareunia. Wet mount microscopy shows clue cells. Which of the following additional findings would confirm the diagnosis?
Vulvovaginitis Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following conditions is associated with the detection of clue cells on microscopy?
- A. Bacterial vaginosis (Correct Answer)
- B. Trichomoniasis
- C. Chlamydial infection
- D. Candidal vulvovaginitis
Explanation: ***Bacterial vaginosis*** - **Clue cells** are the hallmark microscopic finding in **bacterial vaginosis**, characterized by vaginal epithelial cells covered in bacteria with obscured borders. - This condition results from an imbalance in vaginal flora, specifically an overgrowth of anaerobic bacteria. *Trichomoniasis* - This sexually transmitted infection is caused by the parasite *Trichomonas vaginalis*, which can be seen as motile organisms on wet mount microscopy. - **Clue cells** are not a feature of trichomoniasis; instead, **flagellated trichomonads** are observed. *Chlamydial infection* - *Chlamydia trachomatis* is an intracellular bacterium that infects cervical cells, leading to cervicitis or urethritis. - Diagnosis typically involves **nucleic acid amplification tests (NAATs)**; clue cells are not associated with this infection. *Candidal vulvovaginitis* - This condition, commonly known as a yeast infection, is caused by *Candida* species. - Microscopic examination reveals **hyphae and budding yeast forms**, not clue cells.
Question 2: Senile vaginitis is due to :
- A. Diabetes
- B. Gonococcal infection
- C. Oestrogen deficiency (Correct Answer)
- D. Cancer cervix
Explanation: ***Oestrogen deficiency*** - **Senile vaginitis**, also known as **atrophic vaginitis**, is primarily caused by **decreased oestrogen levels**, particularly after menopause. - Reduced oestrogen leads to thinning and drying of the vaginal walls, making them more susceptible to inflammation and infection. *Diabetes* - While uncontrolled **diabetes** can increase the risk of vaginal infections, such as **candidiasis**, it is not the direct cause of senile vaginitis itself. - Diabetic neuropathy can affect vaginal sensation, but does not cause the atrophic changes observed in senile vaginitis. *Gonococcal infection* - **Gonococcal infection** is a sexually transmitted infection that causes acute inflammation of the mucous membranes, but not the long-term atrophic changes seen in senile vaginitis. - It would present with purulent discharge and dysuria, which are distinct from the symptoms of senile vaginitis. *Cancer cervix* - **Cervical cancer** is a malignancy of the cervix and does not directly cause senile vaginitis. - While it can manifest with abnormal vaginal bleeding or discharge, these symptoms are typically due to the tumor itself and not the atrophic changes characteristic of senile vaginitis.
Question 3: A 27-year-old woman presented with a malodorous discharge in the vagina which started a week earlier. On examination, Whiff's test is positive and the gram stain shows the presence of clue cells. This infection is commonly treated with which of the following?
- A. Metronidazole (Correct Answer)
- B. Azithromycin
- C. Nystatin pessary
- D. Tetracycline
Explanation: ***Metronidazole*** - This patient's symptoms (malodorous vaginal discharge, positive **Whiff test**, and presence of **clue cells** on Gram stain) are classic findings for **bacterial vaginosis (BV)**. - **Metronidazole** is the first-line and most effective antibiotic for treating bacterial vaginosis, as it targets the anaerobic bacteria overgrowing in the vagina. *Azithromycin* - **Azithromycin** is primarily used to treat infections like **chlamydia**, gonorrhea, or some respiratory tract infections. - It is **not effective** against the anaerobic bacteria responsible for bacterial vaginosis. *Nystatin pessary* - **Nystatin** is an **antifungal medication** specifically used to treat **vulvovaginal candidiasis (yeast infection)**. - The patient's presentation (malodorous discharge, positive Whiff test, clue cells) does not align with a yeast infection, making nystatin ineffective. *Tetracycline* - **Tetracycline** is a broad-spectrum antibiotic, but it is **not the preferred treatment** for bacterial vaginosis. - Its use is often associated with a higher risk of side effects and is typically reserved for other bacterial infections like **chlamydia**, acne, or Rocky Mountain spotted fever.
Question 4: A pregnant female presents with active herpetic lesions on the vulva. What is the most appropriate management?
- A. Wait & watch
- B. Acyclovir & elective cesarean section (C-section) (Correct Answer)
- C. Acyclovir & allow spontaneous progression of labor
- D. Induction of labor
Explanation: ***Acyclovir & elective cesarean section (C-section)*** - Active **genital herpetic lesions** at the time of delivery pose a significant risk of transmitting **herpes simplex virus (HSV)** to the neonate. - **Acyclovir** can help suppress viral replication, but a **cesarean section** is necessary to prevent direct contact with the lesions during birth, which could lead to severe neonatal HSV infection. *Wait & watch* - This approach is inappropriate due to the high risk of **vertical transmission** of HSV to the neonate if lesions are active during vaginal delivery, potentially causing life-threatening complications. - **Neonatal HSV** can result in significant morbidity and mortality, including neurological damage and disseminated disease. *Acyclovir & allow spontaneous progression of labor* - While **acyclovir** can reduce viral load, it does not completely eliminate the risk of transmission from active lesions during a vaginal birth. - The primary concern is protecting the neonate from direct contact with the **active lesions** in the birth canal. *Induction of labor* - **Induction of labor** does not mitigate the risk of **vertical transmission** from active lesions during a vaginal delivery. - The focus should be on preventing contact with the lesions, not on expediting vaginal birth once active lesions are present.
Question 5: A 25 year old lady presented with curdy white discharge from the vagina is likely to be suffering from:-
- A. Trichomoniasis
- B. Gonococcal vulvovaginitis
- C. Chlamydia trachomatis
- D. Candida vaginitis (Correct Answer)
Explanation: ***Candida vaginitis*** - **Candida vaginitis** is characterized by a **curdy white vaginal discharge**, often described as cottage cheese-like. - This condition is caused by an overgrowth of *Candida* species, typically *Candida albicans*, and is associated with **vaginal itching, burning**, and **dyspareunia**. *Trichomoniasis* - **Trichomoniasis** typically presents with a **frothy, greenish-yellow discharge** and a **foul odor**. - It often causes **severe itching, redness, and irritation**, which differ from the curdy discharge described. *Gonococcal vulvovaginitis* - **Gonococcal vulvovaginitis** in women can cause a **purulent or mucopurulent discharge**, often yellowish. - While it can lead to vaginal irritation, a **curdy white discharge** is not its classic presentation. *Chlamydia trachomatis* - **Chlamydia trachomatis** often causes an **asymptomatic infection**; when symptoms occur, they may include a **mucopurulent discharge**. - A **curdy white discharge** is not a typical symptom of *Chlamydia* infection.
Question 6: A 25-year-old woman presents with thin, gray-white vaginal discharge and mild itching. Microscopy shows clue cells and pH is 5.5. What is the most appropriate treatment?
- A. Metronidazole gel 0.75% for 5 days
- B. Fluconazole 150mg single dose
- C. Metronidazole 500mg BD for 7 days (Correct Answer)
- D. Clindamycin cream 2% for 7 days
Explanation: ***Metronidazole 500mg BD for 7 days*** - The patient's symptoms (thin, gray-white discharge, mild itching), microscopic findings (**clue cells**), and **vaginal pH of 5.5** are classic for **bacterial vaginosis (BV)**. - **Oral metronidazole 500mg twice daily for 7 days** is a highly effective and commonly recommended first-line treatment for BV, targeting anaerobic bacteria responsible for the condition. *Metronidazole gel 0.75% for 5 days* - Metronidazole gel is an alternative treatment for BV, but it is typically prescribed for **5 days**, not 7 days, and is a **vaginal application**, not oral. - While effective, oral metronidazole is often preferred for more severe or recurrent cases, or if patient preference dictates. *Fluconazole 150mg single dose* - **Fluconazole** is an **antifungal medication** used to treat **vulvovaginal candidiasis (yeast infection)**, which typically presents with thick, white, "cottage cheese-like" discharge and severe itching, and is not associated with clue cells. - The presented symptoms and findings are inconsistent with a yeast infection. *Clindamycin cream 2% for 7 days* - **Clindamycin cream** is another effective topical treatment for **bacterial vaginosis**; however, it is typically applied **intravaginally** for 7 days. - While clindamycin is an appropriate antibiotic for BV, oral metronidazole is often favored for its systemic effect and patient convenience in many cases.
Question 7: A 23-year-old woman presents with vulvovaginal itching, burning, and thick white discharge. Microscopy shows budding yeast with pseudohyphae. She reports recurrent episodes. What is the most appropriate management?
- A. Fluconazole 150mg orally as single dose
- B. Topical clotrimazole for 7 days
- C. Weekly fluconazole 150mg for 6 months (Correct Answer)
- D. Metronidazole 500mg orally twice daily for 7 days
Explanation: ***Weekly fluconazole 150mg for 6 months*** - The patient's history of **recurrent episodes** of vulvovaginal candidiasis, coupled with the presence of **budding yeast and pseudohyphae**, indicates a need for **prophylactic treatment**. - **Weekly fluconazole** for an extended period (e.g., 6 months) is the recommended regimen for **recurrent vulvovaginal candidiasis**, aiming to suppress future outbreaks. *Fluconazole 150mg orally as single dose* - A **single dose of fluconazole** is typically effective for **uncomplicated, sporadic vulvovaginal candidiasis**. - It is insufficient to prevent recurrence in a patient with a history of **recurrent candidiasis**. *Topical clotrimazole for 7 days* - **Topical antifungals** like clotrimazole are effective for **acute episodes of candidiasis**, particularly when symptoms are mild or localized. - Similar to a single oral dose, a 7-day course of topical treatment is generally not adequate for **preventing recurrence** in chronic cases. *Metronidazole 500mg orally twice daily for 7 days* - **Metronidazole** is an antibiotic used to treat **bacterial vaginosis** and **trichomoniasis**, which are caused by bacteria and parasites, respectively. - It has **no antifungal activity** and would be ineffective against vulvovaginal candidiasis.
Question 8: A 25-year-old woman presents with vaginal discharge and vulvovaginal irritation. Wet mount shows motile trichomonads. She mentions having a similar infection 2 months ago treated with single-dose metronidazole. What is the most likely explanation for her current infection?
- A. Concurrent bacterial vaginosis
- B. Reinfection from untreated partner (Correct Answer)
- C. Metronidazole resistance
- D. Inadequate initial therapy
Explanation: ***Reinfection from untreated partner*** - **Trichomoniasis** is a sexually transmitted infection, and treatment of only one partner often leads to **reinfection** from the untreated partner. - The recurrence of symptoms within a short period (2 months) after successful treatment strongly suggests exposure to the pathogen again. *Concurrent bacterial vaginosis* - While **bacterial vaginosis** can cause discharge, it is a different infection, and its presence does not explain the recurrence of **trichomonads** found on the wet mount. - Co-occurrence is possible, but it doesn't account for the re-emergence of the *Trichomonas* organism. *Metronidazole resistance* - **Metronidazole resistance** in *Trichomonas vaginalis* is rare, especially after an initial successful treatment with a single dose. - Resistance is usually suspected if symptoms persist *despite* adequate treatment, rather than recurring after a period of being symptom-free. *Inadequate initial therapy* - A single-dose regimen of **metronidazole** is typically an effective and standard treatment for trichomoniasis. - If the initial treatment was truly inadequate, symptoms would likely have persisted or returned much sooner, rather than appearing 2 months later.
Question 9: Which of the following are Amsel's diagnostic criteria? I. Vaginal pH>4.5 II. Positive Whiff test III. Presence of clue cells >20 % IV. Positive bacterial vaginal culture Select the correct answer using the code given below :
- A. I, III and IV
- B. I, II and III (Correct Answer)
- C. I, II and IV
- D. II, III and IV
Explanation: ***I, II and III*** - Amsel's criteria are used for diagnosing **bacterial vaginosis** and include a vaginal pH >4.5, a positive **Whiff test** (amine odor with KOH), and the presence of **clue cells** (>20%) on microscopy. - The presence of at least three out of these four criteria is generally considered diagnostic for bacterial vaginosis. *I, III and IV* - This option incorrectly includes a **positive bacterial vaginal culture** as an Amsel's criterion. - Bacterial vaginal culture is generally not part of Amsel's criteria for diagnosing bacterial vaginosis, as it is often difficult to interpret due to the polymicrobial nature of the condition and doesn't differentiate between normal flora and pathogenic overgrowth. *I, II and IV* - This option also incorrectly includes a **positive bacterial vaginal culture** as an Amsel's criterion. - Amsel's criteria rely on direct, rapid clinical assessment rather than labor-intensive culture methods for diagnosis of bacterial vaginosis. *II, III and IV* - This option incorrectly includes a **positive bacterial vaginal culture** and omits **vaginal pH >4.5**, which is a key component of Amsel's criteria. - The elevated vaginal pH is crucial as it indicates a shift from the normal acidic vaginal environment, making it a critical diagnostic marker.
Question 10: A 26-year-old woman presents with vaginal discharge and dyspareunia. Wet mount microscopy shows clue cells. Which of the following additional findings would confirm the diagnosis?
- A. Pseudohyphae on microscopy
- B. Positive whiff test and vaginal pH > 4.5 (Correct Answer)
- C. WBCs > 10 per high power field
- D. Motile trichomonads
Explanation: ***Positive whiff test and vaginal pH > 4.5*** - The combination of **clue cells**, a **positive whiff test** (amine odor after adding KOH), and a **vaginal pH > 4.5** are diagnostic criteria for **bacterial vaginosis (BV)**. - This classic triad, along with thin, homogeneous discharge, forms part of the **Amsel criteria** for diagnosing BV. *Pseudohyphae on microscopy* - **Pseudohyphae** are characteristic findings in **vulvovaginal candidiasis (yeast infection)**, not bacterial vaginosis. - Candidiasis typically presents with thick, white, "cottage cheese-like" discharge and intense pruritus, which differs from the described symptoms. *WBCs > 10 per high power field* - An increased number of **white blood cells (WBCs)**, specifically polymorphonuclear leukocytes, suggests **inflammation** or infection but is typically *absent* or minimal in uncomplicated bacterial vaginosis. - High WBC counts are more indicative of **trichomoniasis** or **cervicitis**. *Motile trichomonads* - The presence of **motile trichomonads** on wet mount microscopy is diagnostic for **trichomoniasis**, a sexually transmitted infection. - While trichomoniasis can cause vaginal discharge and dyspareunia, its microscopic features are distinct from clue cells.
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