1What are the most common gynecologic complaints?
vaginal discharge, discomfort, and odor
2What are the major causes of vaginal discharge, discomfort, and odor?
bacteria vaginosis, candidiasis, trichomoniasis
3What are tests to differentiate vaginal diseases under the microscope?
wet mount examination
amine of 'whiff' test
potassium hydroxide (KOH) examination
gram stain
4What technique do you use to collect vaginal fluid?
Dacron swab on a plastic shaft or sterile wire loop to obtain vaginal secretions
5What is the pH of vaginal secretions?
3.8 to 4.5
6What is the healthy bacteria in the vagina?
lactobacilli
7What do lactobacilli do?
produce lactic acid and hydrogen peroxide to maintain normal acidic pH
8What is the purpose of hydrogen peroxide?
bactericidal and prevents overgrowth of some microbes such as Gardnerella vaginalis
9What is absence of lactobacilli associated with?
bacterial vaginosis
10What does the wet mount able to quickly detect?
trichomonas vaginalis
11How is a wet mount done?
vaginal swab placed in sterile physiologic saline to release secretions from swab
12How is the KOH and Whiff test done?
one drop of 10% KOH and one drop of vaginal suspension
13What is observed in KOH and Whiff test?
immediately observed for release of fishy odor
14What is the purpose of KOH?
KOH digests cellular elements in order to visualize fungal elements
KOH kills bacteria and cells from the vagina, leaving only yeast
15What are the elements reported in wet mounts?
RBC, WBC
Predominant bacterial morphotypes
yeast, hyphae/pseudo hyphae
trichomonads
clue cells
parabasal cells
basal cells
squamous epithelial cells
16What is normal vaginal bacterial flora?
large rods of lactobacilli account for 50-90% of microbes of healthy vagina
17What is an indicator of imbalance in microbial flora?
decrease of lactobacilli relative to amount of squamous epithelial cells
18When vaginal bacteria abnormal?
increased numbers of preponderance of other bacterial morphotypes
19When does WBC increase normally (vaginal)?
WBC is higher during ovulation and menses
20When is RBC usually present?
not normally present unless during menses
21What cells line the vagina?
stratified squamous epithelium (predominant in wet mounts of healthy vagina)
22How can you identify stratified squamous epithelium?
large (30-60mm), thin, flat, flagstone shaped appearance
Have small, centrally located nucleus and large amount of cytoplasm which becomes finely granulated as cell ages
23When are clue cells formed?
formed when numerous bacteria adhere to membranes of epithelial cells
24What are clue cells diagnostic of?
bacterial vaginosis
25What does clue cells look similar to?
aging squamous epithelial cells that are normal
26What does clue cells look like?
shaggy-appearing edges; nuclei may not be visible
27What do basal cells look like?
10-16 um, similar to WBC size
28When is basal cell presence abnormal?
when present in wet mount
29What is the nucleus/cytoplasm ratio in basal cells?
1:2
30What are basal cells accompanied with?
numerous WBCs
31What disease has presence of basal cells?
desqumative inflammatory vaginitis
32What are the size of parabasal cells?
15-40 um
33What is the normal amount of parabasal cells?
none to very few present in normal vaginal samples
34When does parabasal cells increase normally?
menses or postmenopausal period
35What does an increased number of parabasal cells indicate? (disease)
atrophic vaginitis and inflammatory vaginitis
36What is the appearance of parabasal cells?
oval ot round with small nucleus to cytoplasm ratio (1:1 or 1:2)
37What are trichomonads?
flagellated protozoans that infect and cause inflammation of vaginal epithelium
38What is the appearance of trichomonads?
pear or turnip shaped unicellular bodies
identified by jerky movement due to 4 anterior flagella and an undulating membrane
39What is the average size of trichomonads?
average 15 mm long; can vary from 5 to 30 mm
40What is the optimal growth of trichomonads?
optimal growth at pH 6.0
41What do trichomonads resemble when dead (not moving)?
WBC
42What is toxic to trichomonads?
stains
43What is the most common gynecologic infection?
trichomoniasis
44How is trichomoniasis transmitted?
sexually (usually)
tranmission of HIV is facilitated in women with trichomoniasis
45What is a risk factor for premature labor or rupture of membranes?
trichomoniasis
46What happens in bacterial vaginosis?
lactobacilli replaced by overgrowth of Gardnerella vaginalis and a facultative anaerobe
47What the symptoms of bacterial vaginosis?
often asymptomatic except for foul discharge
48Describe bacterial vaginosis under microscope
presence of clue cells and an absence of lactobacilli
49What test is positive for bacterial vaginosis?
positive amine whiff test
50What is the pH of bacterial vaginosis?
>4.5
51What is the second most common cause of vaginitis?
candidiasis
52What is responsible for candidiasis?
candida albicans (part of normal flora but overgrowth occurs with changes in pH or normal flora)
53What are the symptoms of candiasis?
vulvovaginal itching, soreness, external dysuria, and a white, curd like discharge
54What tests lead to candidiasis?
wet mount and KOH reveals budding yeast and/or pseudohyphae and increased WBC
55What tests are normal in candidiasis?
pH is normal and amine test is negative
56What is a common cause of candidiasis?
caused by a use of broad-spectrum antibiotics or oral contraceptives
57What predisposes to candida?
diabetes, HIV, or immunosuppression
58When does atrophic vaginitis occur?
in peri- and postmenopausal women
59What happens in atrophic vaginitis?
thinning of vaginal eptihelium and decrease in glycogen production resulting in dryness, sorness, and spotting
60What are the bacteria levels in atrophic vaginitis?
decrease in lactobacilli and overgrowth of other bacteria
61What is the pH of atrophic vaginitis?
pH >4.5
62What is the treatment for atrophic vaginitis?
replacement of estrogen