Question 1

A sexually active young female reports vaginal discharge and moderate vulvovaginal irritation. The examination reveals a white, noninflammatory discharge adhering to the vaginal walls, clue cells on microscopic examination, and a positive KOH (potassium hydroxide) whiff test. What will the provider do next?

A) Obtain cultures of the vaginal discharge
B) Order a gynecologic referral for evaluation and treatment
C) Prescribe oral metronidazole 500 mg twice a day for 7 days
D) Screen the patient for gonorrhea and chlamydia

C

Accepted Answer

The clinical scenario is consistent with bacterial vaginosis (BV), a common vaginal infection characterized by a malodorous, noninflammatory vaginal discharge. The presence of clue cells on microscopic examination and a positive KOH whiff test are additional diagnostic criteria for BV. Cultures of the vaginal discharge are not typically necessary for the diagnosis of BV. A gynecologic referral may be appropriate in some cases, but initial management can be provided by the primary care provider. Screening for gonorrhea and chlamydia is important in sexually active young females presenting with vaginal symptoms, but these infections do not cause the characteristic discharge associated with BV. The recommended treatment for BV is oral metronidazole 500 mg twice daily for 7 days.

Question 2

A female patient reports vulvar pruritus and dyspareunia. The provider notes white papules on the vulva with thinning of the epithelium. What condition does the provider suspect?&#10;A) Bartholin's duct cyst&#10;B) Lichen sclerosis&#10;C) Sexually transmitted infection&#10;D) Vulvar psoriasis

Accepted Answer

The presence of white papules and thinning of the epithelium on the vulva are characteristic of lichen sclerosis, a chronic inflammatory condition that can cause itching, burning, and pain. Bartholin's duct cysts typically present as a painless, fluid-filled lump near the vaginal opening. Sexually transmitted infections may cause genital sores or discharge, but do not typically cause white papules. Vulvar psoriasis can cause scaly, red, and itchy patches, but does not typically present with white papules.

Question 3

A postmenopausal woman is diagnosed with lichen planus. After several weeks of treatment with a potent corticosteroid ointment, the woman reports improvement in itching, but states that she has extreme vaginal dryness. What will the provider recommend?

A) Increasing the frequency of the corticosteroid application
B) Taking diphenhydramine daily at bedtime
C) Using a topical estrogen cream along with the steroid
D) Using petrolatum ointment to minimize drying

C

Accepted Answer

Topical corticosteroids can be effective in treating lichen planus, but they can also cause vaginal dryness as a side effect. Topical estrogen cream can help alleviate this symptom by restoring moisture to the vagina.

Deck 153: Vulvar and Vaginal Disorders