MCQ – 72048

A patient presented with ‘Frothy’, greenish vaginal discharge with a ‘musty’ malodorous smell.Pap Smear shows the following abnormality.What would be the treatment of choice?

A.	Penicillin
B.	Ceftriaxone
C.	Fluconazole
D.	Metronidazole

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Correct Answer � D Explanation

Ans:D.)Metronidazole.

Pap Smear shows Trichomonas Vaginalis Infection.: Numerous organisms free and feeding on squamous cells .

Features:

• Low power: grey blob with a nucleus, may be pear-shaped:
  • Size: approximately 30 micrometres.
  • Shape: usually oval, may have teardrop-shaped.
  • Flagellum – hair-thin locomotive stucture, usu. barely visible at 200X – diagnostic feature.

Cytopathological associations:

• Acute inflammation (neutrophils), often marked – key feature at low power.
• Reactive squamous cells with:
  • Nucleoli,
  • Perinuclear halos, and
  • Moth-eaten cytoplasm; cytoplasm that has multiple vacuoles with star-like spaces.

Notes:

• Trichomonas is tricky – it is easy to miss if one is not suspicious, in the context of inflammation.
• May vaguely resemble a neutrophil:
  • Flagellum useful to differentiate.
  • Neutrophil has multiple lobulations of the nucleus.
• May be seen in association of Leptothrix.
  • Appearance: long, hair-like.
  • Size: ~0.5 x 20 micrometres.