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Free notes, MCQs, tables & flowcharts for USMLE Step 3 Microbiology
A 28-year-old woman comes to the physician because of a 4-day history of lower abdominal pain and pain with urination. Five months ago, she was treated for gonococcal urethritis. She recently moved in with her newlywed husband. She is sexually active with her husband and they do not use condoms. Her only medication is an oral contraceptive. Her temperature is 37.5°C (99.7°F) and blood pressure is 120/74 mm Hg. There is tenderness to palpation over the pelvic region. Pelvic examination shows a normal-appearing vulva and vagina. Laboratory studies show: Leukocyte count 8,400/mm3 Urine pH 6.7 Protein trace WBC 60/hpf Nitrites positive Bacteria positive Which of the following is the most likely causal organism?
AEnterococcus faecalis
BKlebsiella pneumoniae
CNeisseria gonorrhoeae
DEscherichia coli
EStaphylococcus saprophyticus
A 28-year-old woman presents with a malodorous vaginal discharge and itchiness that have lasted for 15 days. She reports that the smell of the discharge is worse after intercourse and is accompanied by a whitish-gray fluid. She has no significant past medical or gynecological history. She is in a stable monogamous relationship and has never been pregnant. She is diagnosed with bacterial vaginosis and prescribed an antimicrobial agent. Which of the following diagnostic features is consistent with this patient’s condition?
AVaginal fluid pH > 4.5, clue cells present on a saline smear of the vaginal secretions, along with a fishy odor on addition of KOH
BVaginal fluid pH < 4.5, lactobacilli predominance on the microscopic examination of the vaginal secretions, which are scant and clear
CVaginal fluid pH > 5.0, motile flagellated pyriform protozoa seen on the microscopic examination of the vaginal secretions
DVaginal fluid pH > 4.0, hyphae on the microscopic examination of the vaginal secretions after the addition of KOH
EVaginal fluid pH > 6.0, scant vaginal secretions, increased parabasal cells
A 24-year-old woman calls her gynecologist complaining of vaginal odor and vaginal discharge. She had an intrauterine device placed last year and does not use condoms with her boyfriend. She has a past medical history of constipation and depression. She recently was successfully treated for a urinary tract infection with a 2-day course of antibiotics. Physical exam demonstrates an off-white vaginal discharge and a strong odor. Pelvic exam demonstrates an absence of cervical motion tenderness and no adnexal tenderness. Which of the following is the most likely diagnosis?
AInflammatory bacterial infection
BPregnancy within the uterine tubes
CPhysiologic discharge secondary to normal hormonal fluctuations
DInsufficiently treated urinary tract infection
EBacterial vaginosis
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