Bacterial Vaginosis

BACTERIAL VAGINOSIS

Q. 1

True about Bacterial vaginosis :

 A

Fishy odour discharge

 B

Grey discharge

 C

Clue cells found

 D

All of these

Q. 1

True about Bacterial vaginosis :

 A

Fishy odour discharge

 B

Grey discharge

 C

Clue cells found

 D

All of these

Ans. D

Explanation:

All of these

Grey discharge; Clue cells found; Fishy odour discharge; and Caused by Gardenella vaginalis


Q. 2

Bacterial vaginosis is characterised by :

 A

pH < 4.5

 B

Clue cell

 C

Amine test is positive

 D

B and C both

Q. 2

Bacterial vaginosis is characterised by :

 A

pH < 4.5

 B

Clue cell

 C

Amine test is positive

 D

B and C both

Ans. D

Explanation:

B and C both

Clue cells; Amide test is positive; and Sexually transmitted  

Bacterial vaginosis : It is characterised by

  • Greyish white vaginal secretions thinly coating the vaginal walls°
  • pH is 4.5°
  • Whiff’s test / Amine test – Positive (i.e. addition of 10% KOH to vaginal secretions produces fishy odour).° Microscopy in Bacterial vaginosis shows
  • Clue cells°
  • I number of gardenella vaginalis°
  • number of lactobacilli°
  • leucocytes (conspicuously absent)°

As far as option    is concerned i.e., it is sexually transmitted – only Williams Gynae. says it is not transmitted  


Q. 3

A 40 — years — old woman presented to the gyne­cologist with complaints of profuse vaginal dis­charge. There was no discharge from the cervix on the speculum examination. The diagnosis of bacterial vaginosis was made based upon all of the following findings on microscopy except :

 A

Abundance of gram variable coccobacilli

 B

Absence of Lactobacilli

 C

Abundance of polymorphs

 D

Present of clue cells

Q. 3

A 40 — years — old woman presented to the gyne­cologist with complaints of profuse vaginal dis­charge. There was no discharge from the cervix on the speculum examination. The diagnosis of bacterial vaginosis was made based upon all of the following findings on microscopy except :

 A

Abundance of gram variable coccobacilli

 B

Absence of Lactobacilli

 C

Abundance of polymorphs

 D

Present of clue cells

Ans. C

Explanation:

Ans. is c i.e. Abundance of polymorphs 

 In Bacterial vaginosis, polymorphs are either absent or there is only a slight increase.


Q. 4

Consider the following characteristics of vaginal discharge in bacterial vaginosis :

 A

Green and thick

 B

pH < 4.5

 C

Increase in number of lactobacilli

 D

Whiff test positive

Q. 4

Consider the following characteristics of vaginal discharge in bacterial vaginosis :

 A

Green and thick

 B

pH < 4.5

 C

Increase in number of lactobacilli

 D

Whiff test positive

Ans. D

Explanation:

Whiff test positive


Q. 5

Drug of choice in bacterial vaginosis is :

 A

Metronidazole

 B

Doxycycline

 C

Clindamycin

 D

Ciprofloxacin

Q. 5

Drug of choice in bacterial vaginosis is :

 A

Metronidazole

 B

Doxycycline

 C

Clindamycin

 D

Ciprofloxacin

Ans. A

Explanation:

Metronidazole


Q. 6

Bacterial vaginosis does not include?

 A Profuse creamy discharge
 B

Clue cells present

 C Positive whiff test
 D

Absent leucocytes

Q. 6

Bacterial vaginosis does not include?

 A Profuse creamy discharge
 B

Clue cells present

 C Positive whiff test
 D

Absent leucocytes

Ans. A

Explanation:

Profuse creamy discharge REF: 12th edition of Novak’s Gynecology p. 192, shaw 13th ed p 129, Repeat in December 2011

Bacterial vaginosis is diagnosed on the basis of the following findings:

  • A fishy vaginal odour, which is particularly noticeable following coitus, and vaginal discharge are present.
  • Vaginal secretions are gray and thinly coat the vaginal walls.
  • The pH of these secretions is higher than 4.5 (usually 4.7 to 5.7).
  • Microscopy of the vaginal secretions reveals an increased number of clue cells, and leukocytes are conspicuously absent. In advanced cases of BV, more than 20% of the epithelial cells are clue cells.
  • The addition of KOH to the vaginal secretions (the “whiff” test) releases a fishy, amine-like odor.
  • Culture of G. vaginalis is not recommended as a diagnostic tool because of its lack of specificity.

Q. 7 “Whiff” Test is done for:
 A Bacterial vaginosis
 B Trichomonas
 C Candida
 D Gonorrhoea
Q. 7 “Whiff” Test is done for:
 A Bacterial vaginosis
 B Trichomonas
 C Candida
 D Gonorrhoea
Ans. A

Explanation:

Bacterial vaginosis


Q. 8

A middle aged woman presented with fishy odour vaginal discharge shows ‘clue cells’ in a wet preparation. She probably has:

 A

Bacterial vaginosis

 B

Chlamydia trachomatis

 C

Neisseria gonorrhoeae

 D

Trichomonas

Q. 8

A middle aged woman presented with fishy odour vaginal discharge shows ‘clue cells’ in a wet preparation. She probably has:

 A

Bacterial vaginosis

 B

Chlamydia trachomatis

 C

Neisseria gonorrhoeae

 D

Trichomonas

Ans. A

Explanation:

Clue cells are the most reliable indicators of bacterial vaginosis (BV).

These vaginal epithelial cells contain many attached bacteria, which create a poorly defined stippled cellular border.

The positive predictive value of this test for the presence of BV is 95 percent.

Clinical criteria for diagnoses include,
  • Homogeneous white, noninflammatory discharge
  • Microscopic presence of clue cells
  • Vaginal discharge with pH >4.5
  • Fishy odor with or without addition of 10% potassium hydroxide
Three of these 4 criteria are required to make a clinical diagnosis of bacterial vaginosis.
 
Ref: Hoffman B.L., Schorge J.O., Schaffer J.I., Halvorson L.M., Bradshaw K.D., Cunningham F.G., Calver L.E. (2012). Chapter 3. Gynecologic Infection. In B.L. Hoffman, J.O. Schorge, J.I. Schaffer, L.M. Halvorson, K.D. Bradshaw, F.G. Cunningham, L.E. Calver (Eds), Williams Gynecology, 2e.

Q. 9

A sexually active female presented with complains of a milky, homogenous, malodorous (“fishy” odour), non irritating discharge. ‘Clue cells’ are seen microscopically from the vaginal discharge. Clue cells are seen in:

 A

Bacterial vaginosis

 B

Candidiasis

 C

Trichomoniasis

 D

Gonorrhoea

Q. 9

A sexually active female presented with complains of a milky, homogenous, malodorous (“fishy” odour), non irritating discharge. ‘Clue cells’ are seen microscopically from the vaginal discharge. Clue cells are seen in:

 A

Bacterial vaginosis

 B

Candidiasis

 C

Trichomoniasis

 D

Gonorrhoea

Ans. A

Explanation:

Presence of clue cells (>20% of epithelial cells) on microscopy is one of the diagnostic criteria of bacterial vaginosis.

Clue cells are identified as numerous stippled or granulated epithelial cells. This appearance is caused by the adherence of G vaginalis organisms to the edges of the vaginal epithelial cells.

Ref: Bornstein J. (2013). Chapter 39. Benign Disorders of the Vulva & Vagina. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.

Q. 10

A 30 year old female presents to the clinic with complaints of fishy discharge per vagina. On examination, vagina is not erythematous and cervix looks normal. Which of the following criteria is NOT required for the diagnosis of bacterial vaginosis?

 A

Plenty of lactobacilli

 B

pH > 4.5

 C

Whiff’s test positive

 D

Clue cells

Q. 10

A 30 year old female presents to the clinic with complaints of fishy discharge per vagina. On examination, vagina is not erythematous and cervix looks normal. Which of the following criteria is NOT required for the diagnosis of bacterial vaginosis?

 A

Plenty of lactobacilli

 B

pH > 4.5

 C

Whiff’s test positive

 D

Clue cells

Ans. A

Explanation:

Diagnosis of bacterial vaginosis is made on the basis of Amsel criteria. According to this criteria bacterial vaginosis is present if 3 of the following findings are present:

1) Elevated vaginal pH more than 4.5
2) Positive amine odor when vaginal fluid is mixed with 10% KOH – WHIFF TEST
3) Presence of clue cells (squamous epithelial cells covered with adherent bacteria) in a saline preparation of vaginal fluid
4) Homogenous vaginal discharge
 
In bacterial vaginosis, lactobacilli producing strains are greatly diminished and are replaced with large number of Gardnerella vaginalis. Decline in lactobacilli which normally produce lactic acid, result in increased vaginal pH. This increase in pH allows overgrowth of anaerobic bacteria.

Ref: CURRENT Diagnosis & Treatment of Sexually Transmitted Diseases, chapter 11


Q. 11

A middle aged female complained about milky discharge with fishy odor. Microscopic examination of vaginal discharge shows clue cells. What is she suffering from?

 A

Bacterial vaginosis

 B

Herpes virus

 C

Syphilis

 D

Toxoplasmosis

Q. 11

A middle aged female complained about milky discharge with fishy odor. Microscopic examination of vaginal discharge shows clue cells. What is she suffering from?

 A

Bacterial vaginosis

 B

Herpes virus

 C

Syphilis

 D

Toxoplasmosis

Ans. A

Explanation:

Criteria for bacterial vaginosis:

  • Elevated vaginal pH (>4.5)
  • Positive amine odor when vaginal fluid is mixed with 10% potassium hydroxide (KOH)—the so-called “whiff” test
  • Presence of clue cells (squamous epithelial cells covered with adherent bacteria) in a saline (wet mount) preparation of the vaginal fluid
  • Homogenous milky or creamy vaginal discharge

According to this criteria, bacterial vaginosis is present if three of the following findings are present. 

 
Ref: Schwebke J.R. (2007). Chapter 11. Bacterial Vaginosis. In J.D. Klausner, E.W. Hook III (Eds). CURRENT Diagnosis & Treatment of Sexually Transmitted Diseases.

Q. 12

Which of the following genital infections is associated with preterm labour ?

 A

Human papilloma virus

 B

Trichmonas vaginitis

 C

Monilial vaginitis

 D

Bacterial vaginosis

Q. 12

Which of the following genital infections is associated with preterm labour ?

 A

Human papilloma virus

 B

Trichmonas vaginitis

 C

Monilial vaginitis

 D

Bacterial vaginosis

Ans. D

Explanation:

Bacterial vaginosis


Q. 13

True about genital infection in bacterial vaginosis are all EXCEPT:      

September 2012

 A

Clue cells present

 B

Gardnerella is the causative agent

 C

Pruritis seen

 D

Grey and foul smelling discharge

Q. 13

True about genital infection in bacterial vaginosis are all EXCEPT:      

September 2012

 A

Clue cells present

 B

Gardnerella is the causative agent

 C

Pruritis seen

 D

Grey and foul smelling discharge

Ans. C

Explanation:

Ans. C i.e. Pruritis seen

Bacterial vaginosis causes minimal vulval irritation

Bacterial vaginosis

  • Cause: Multibacterial (Hemophilus vaginalis, Gardenella vaginalis etc.)
  • Clinical presentation:

–          Milky,

Homogenous and

–          Adherent discharge

  • Vaginal pH: Alkaline (greater than 4.5)
  • Histological feature: Clue cells
  • DOC: Metronidazole

Q. 14

Features of Bacterial vaginosis are all of the following except:

September 2010

 A

Abundant lactobacillus

 B

pH>4.5

 C

Clue cells

 D

It is sexually transmitted

Q. 14

Features of Bacterial vaginosis are all of the following except:

September 2010

 A

Abundant lactobacillus

 B

pH>4.5

 C

Clue cells

 D

It is sexually transmitted

Ans. A

Explanation:

Ans. A: Abundant lactobacillus

To make a diagnosis of bacterial vaginosis, a speculum examination and subsequent swabs from high in the vagina should be obtained. These swabs should be tested for:

  • A characteristic “fishy” odor on wet mount. This test, called the whiff test, is performed by adding a small amount of potassium hydroxide to a microscopic slide containing the vaginal discharge. A characteristic fishy odor is considered a positive whiff test and is suggestive of bacterial vaginosis.
  • Loss of acidity. To control bacterial growth, the vagina is normally slightly acidic with a pH of 3.8-4.2. A swab of the discharge is put onto litmus paper to check its acidity. A pH greater than 4.5 is considered alkaline and is suggestive of bacterial vaginosis.
  • The presence of clue cells on wet mount. Similar to the whiff test, the test for clue cells is performed by placing a drop of sodium chloride solution on a slide containing vaginal discharge. If present, clue cells can be visualized under a microscope. They are so-named because they give a clue to the reason behind the discharge. These are epithelial cells that are coated with bacteria.

Q. 15

A middle aged female complained about milky discharge with fishy odor. Microscopic examination of vaginal discharge shows the presance of cells as marked in the photomicrograph below. What is she suffering from? 

 A

Bacterial vaginosis.

 B

Herpes virus.

 C

Syphilis.

 D

Toxoplasmosis.

Q. 15

A middle aged female complained about milky discharge with fishy odor. Microscopic examination of vaginal discharge shows the presance of cells as marked in the photomicrograph below. What is she suffering from? 

 A

Bacterial vaginosis.

 B

Herpes virus.

 C

Syphilis.

 D

Toxoplasmosis.

Ans. A

Explanation:

Clue cells are seen in bacterial vaginosis.

Criteria for bacterial vaginosis:

  • Elevated vaginal pH (>4.5)
  • Positive amine odor when vaginal fluid is mixed with 10% potassium hydroxide (KOH)—the so-called“whiff” test
  • Presence of clue cells (squamous epithelial cells covered with adherent bacteria) in a saline (wet mount) preparation of the vaginal fluid
  • Homogenous milky or creamy vaginal discharge

According to this criteria, bacterial vaginosis is present if three of the following findings are present. 


Q. 16

 Cell type (Photograph) is seen in Vagina of a case of 

 A

 HSV

 B

 Candidiasis

 C

Bacterial vaginosis

 D

Trichomonas gaginitis

Q. 16

 Cell type (Photograph) is seen in Vagina of a case of 

 A

 HSV

 B

 Candidiasis

 C

Bacterial vaginosis

 D

Trichomonas gaginitis

Ans. C

Explanation:

These cells are clue cells

Bacterial vaginosis (BV) is a disease of the vagina caused by excessive growth of bacteria.Common symptoms include increased vaginal discharge that often smells like fish. The discharge is usually white or gray in color. Burning with urination may occur. Itching is uncommon.Occasionally, there may be no symptoms.Having BV approximately doubles the risk of infection by a number of other sexually transmitted infections, including HIV/AIDS. It also increases the risk of early delivery among pregnant women


Q. 17

Identify the infection in vagina as shown in the photograph below ? 

 A

HIV.

 B

Syphilis.

 C

Bacterial vaginosis

 D

None of the above.

Q. 17

Identify the infection in vagina as shown in the photograph below ? 

 A

HIV.

 B

Syphilis.

 C

Bacterial vaginosis

 D

None of the above.

Ans. C

Explanation:

Bacterial vaginosis is a mild infection of the vagina caused by bacteria. Normally, there are a lot of “good” bacteria and some “bad” bacteria in the vagina. The good types help control the growth of the bad types. In women with bacterial vaginosis, the balance is upset. There are not enough good bacteria and too many bad bacteria.

The most common symptom is a smelly vaginal discharge. It may look grayish white or yellow. A sign of bacterial vaginosis can be a “fishy” smell, which may be worse after sex. About half of women who have bacterial vaginosis do not notice any symptoms.


Q. 18

A 25 year old female patient presents with fishy odour vaginal discharge.Pap Smear shows the following picture.What can be the most possible diagnosis?

 A

Trichomoniasis

 B

Bacterial Vaginosis

 C

Candidiasis

 D

Actinomycosis

Q. 18

A 25 year old female patient presents with fishy odour vaginal discharge.Pap Smear shows the following picture.What can be the most possible diagnosis?

 A

Trichomoniasis

 B

Bacterial Vaginosis

 C

Candidiasis

 D

Actinomycosis

Ans. B

Explanation:

Ans:B.)Bacterial Vaginosis.

Indicator cells also known as “Clue Cells” form the characteristic picture of BV. 
Note the presence of multiple microorganisms, which are attached to a single squamous epithelial cell.



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