Glynecological problems

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Abnormal uterine bleeding is a common gynecologic complaint. Review the following scenarios and determine a likely cause and describe the mechanism that leads to the abnormal bleeding pattern

Scenario 3: A 21-year-old woman is having episodes of amenorrhea and infrequent menses. Her menarche was at the age of 14 and her menses have sometimes been regular. She is overweight and says despite her efforts to lose weight, she does not do so. She is generally very healthy otherwise and the only medication she is taking is doxycycline for acne, which she feels is getting worse. She said her mother’s menstrual pattern was the same and that her mother told her she had trouble getting pregnant (the patient is an only child). She is sexually active, her partner uses condoms consistently, and her urine pregnancy is negative.

Part 3 

Most women at some point in their life will get a vaginal infection. Vaginal infection can be characterized by complaints of vaginal discharge. Three common causes of vaginal discharge are bacterial vaginosis, trichomoniasis, and vulvovaginal candidiasis. Review the following case and answer the questions. 

Case

A 40-year-old woman comes in complaining of an increased thin whitish vaginal discharge that started about 5 days ago. She said it is so much that she needs to wear a small sanitary pad. She also noted that she had a funny odor after having sexual intercourse, and she says the odor continues despite her attempts to control it with douching. Physical examination reveals a thin white discharge around the vaginal wall with no erythema. Examination of the discharge includes a positive KOH whiff test and a vaginal pH > 4.5. Vaginal microscopy reveals clue cells. 

Answer the following questions or provide responses based on this case. 

1. What is a likely cause of the vaginal discharge?  

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    • Trichomoniasis
    • Bacterial vaginosis
    • Vulvovaginal candidiasis

2. Which of the clinical manifestations confirms the diagnosis?  

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    • The thin white discharge
    • Malodorous discharge
    • Presence of clue cells on a saline wet mount slide

3. The cause of this vaginal discharge disorder is due to:  

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    • An alteration in the vaginal flora
    • Overgrowth of yeast due to antibiotic use
    • A sexually transmitted organism, T. pallidum

4. This item is optional. Which is the primary treatment of this vaginal discharge disorder?  

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    • Fluconazole
    • Metronidazole
    • Clindamycin

5. Describe the mode of transmission, common organism, clinical manifestations, and treatment of the other two diagnoses not chosen in question 1.