Mcq on bacterial vaginosis for neet pg entrance exam, mci screening, fmge, plab and usmle

1. Q:1
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
Correct 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.
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Q:2 All are features of Ureaplasma urealyticum, EXCEPT:
A: Non gonococcal urethritis
B: Salpingitis
C: Epididymitis
D: Bacterial vaginosis
Correct Ans:B
Explanation
Ureoplasma urealyticum, have been isolated directly from affected fallopian tubes but
the absence of antibody responses, and failure to produce salpingitis in subhuman
primates makes them as unlikely cause of disease at that site.
Ref: Topley and Wislon’s Microbiology and Microbial Infections, 9th Edition, Page
1014 ; Medical Microbiology By Greenwood, 15th Edition, Page 42

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Q:3 'Clue cells' are seen in:
A: Bacterial vaginosis
B: Vaginal Candidiasis
C: Chlamydial vaginosis
D: Trichomoniasis
Correct Ans:A
Explanation
Clue cells are epethelial cells covered with bacteria and are identified on microscopy.
They are characteristic of Bacterial Vaginosis.
Ref: Clinical Obstetrics and Gynaecology by Brian A. Magowan, Philip Owen, James
Drife, Pages 125­134.
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Q:4
A 40­years­old 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: Presence of clue cells
Correct Ans:C
Explanation
Bacterial vaginosis is characterized by loss of Lactobacillus­predominant vaginal flora
and replacement with Gardnerella vaginalis, Escherichia coli, Anaerobic bacteria, or
Microplasma hominis, and presence of ‘clue cells’. Bacterial vaginosis is associated
with a decreased number of polymorphs and not with their abundance.
Ref: Shaw’s Textbook of Gynaecology, 13th Edition, Page 129; Harrison’s Principles of
Internal Medicine, 16th Edition, Page 766.
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Q:5
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

3. B: Candidiasis
C: Trichomoniasis
D: Gonorrhoea
Correct 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.
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Q:6 Drug of choice for bacterial vaginosis is:
A: Metronidazole
B: Erythromycin
C: Tetracycline
D: Nystatin
Correct Ans:A
Explanation
Metronidazole or clindamycin are used in the treatment of bacterial vaginosis.
Bacterial vaginosis is caused by an alteration in the normal vaginal flora. In this
condition there is overgrowth of organisms such as Gardnerella vaginalis, Mobiluncus
spp., anaerobic gram­negative rods and Peptostreptococcus spp.
According to Amsel's criteria, diagnosis of this condition requires presence of 3 out of 4
of the following criteria:
Presence of homogeneous vaginal discharge.
Presence of amine odor when potassium hydroxide solution is added to vaginal
secretions (whiff test).
Presence of clue cells (>20% of epithelial cells) on microscopy. Clue cells are
identified as numerous stippled or granulated epithelial cells.
Vaginal pH >4.5.
Ref: Bornstein J. (2013). Chapter 39. Benign Disorders of the Vulva & Vagina.
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Q:7
Which of the following condition is associated with the detection of clue cells on
microscopy?
A: Candidial vaginosis

4. B: Bacterial vaginosis
C: Trichomoniasis
D: Chlamydial infection
Correct Ans:B
Explanation
Clue cells are squamous epithelial cells with a fine granular epithelium and has
indistinct border due to coccobacilli. They are the most reliable indicator of bacterial
vaginosis. Clue cells are seen in more than 95% of patients with bacterial vaginosis.
Amsel criteria for diagnosis of bacterial vaginosis:
Presence of objective signs of increased white homogeneous vaginal discharge
Vaginal discharge with pH of >4.5
Liberation of a distinct fishy odor due to trimethylamine, immediately after
vaginal secretions are mixed with a 10% solution of KOH
Microscopic demonstration of clue cells.
Ref: Marrazzo J.M., Holmes K.K. (2012). Chapter 130. Sexually Transmitted Infections:
Overview and Clinical Approach. In D.L. Longo, A.S. Fauci, D.L. Kasper, S.L. Hauser, J.L.
Jameson, J. Loscalzo (Eds), Harrison's Principles of Internal Medicine, 18e.
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Q:8 Bacterial vaginosis does NOT include:
A: Profuse creamy discharge
B: Clue cells present
C: Positive whiff test
D: Absent leucocytes
Correct Ans:A
Explanation
Gardnerella vaginalis, facultatively anaerobic gram­variable rod, is one of the
organismsresponsible for bacterial vaginosis (BV).
The vaginal discharge of BV is characteristically described as a thin, gray, homogeneous
fluid that is adherent to the vaginal mucosa. A fishy vaginal odour, which is particularly
noticeable following coitusis present.
Demonstration of clue cells on a saline smear is the most specific criterion for
diagnosing BV.
The whiff test may be positive in up to 70% of BV patients.
The vaginal discharge of patients with BV is notable for its lack of polymorphonuclear
leukocytes (PMNs), typically 1 or less than 1 PMN per vaginal epithelial cell.
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5. Q:9
Koilocytes with dyskeratosis and perinuclear halo on pap smear is pathognomonic
of which of the following?
A: HPV infection
B: Metaplasia
C: Dysplasia
D: Bacterial vaginosis
Correct Ans:A
Explanation
The presence of abnormal koilocytes (keratinocytes with pyknotic, deeply blue nuclei
surrounded by a halo and clear cytoplasm with a paucity of keratohyaline granules), or
koilocytosis, is a characteristic feature of productive HPV infection. Other cytologic
markers of HPV infection include acanthosis, dyskeratosis, and multinucleation.
Virus multiplication is confined to the host cell nucleus. Consequently, infected cells
exhibit a high degree of nuclear atypia.
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Q:10
A patient presented to you with vaginal discharge. Whiff test was positive. What
is the diagnosis?
A: Bacterial vaginosis
B: Candidal vaginitis
C: Gonococcal infection
D: Chlamydial infection
Correct Ans:A
Explanation
Whiff positive ­ Bacterial vaginosis
Gram staining ­ Diplococcus ­ Gonococci
Gram staining ­ No organism ­ Chlamydial infection
KOH mount ­ Yeast cells ­ Candida vaginitis
Ref: Essentials of Gynaecology by Lakshmi Seshadri, Edition 1, page ­ 176.
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Q:11 The most common cause of tubal block in India is:
A: Gonorrhea infection
B: Chlamydia infection
C: Tuberculosis

6. D: Bacterial vaginosis
Correct Ans:C
Explanation
In India tuberculosis (TB) is the common cause of genital tract infection which may
lead tubal obstruction. There is a history of TB in 68% of women who complained of
infertility, amenorrhea, and oligomenorrhea.
Ref: Handbook on Managing Infertility By Jaideep Malhotra, 2012, Page 45; Article:
Overview of Tuberculosis of The Female Genital Tract By Chowdhury NN, 1996.
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Q:12 For diagnosing which of the following infection is Whiff test done?
A: Bacterial vaginosis
B: Vaginal Candidiasis
C: Syphilis
D: Genital tuberculosis
Correct Ans:A
Explanation
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. The
presence of clue cells on wet mount is similar to the whiff test.
Diagnosis of a yeast infection is done either via microscopic
examination or culturing.
Serological testing is the most frequently used approach in the
laboratory diagnosis of syphilis.
Histopathological and mycobacteriological examinations have
limited utility in the diagnosis of genital tuberculosis.
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Q:13 Which of the following infection is associated with the presence of Clue cells?
A: Bacterial vaginosis
B: HSV 2 infection

7. C: Syphilis
D: Trichomoniasis
Correct Ans:A
Explanation
Clue cells are vaginal epithelial cells that are covered with bacteria giving them
granular appearance and indistinct borders. It is a result of altered vaginal bacterial
flora which occur in Bacterial vaginosis. Microscopic examination for clue cells is
performed with a wet mount or a stained preparation using Papinicolaou or gram stain.
Diagnosis of bacterial vaginosis requires the presence of 3 out of 4 clinical
abnormalities:
Objective signs of increased white homogeneous vaginal discharge.
Vaginal discharge with pH of > 4.5.
Positive Whiff’s test or Amines test (addition of 10%KOH to vaginal discharge
produces fishy odour, this is attributable to volatile amines such as
trimethylamine).
Microscopic demonstration of Clue cells.
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Q:14
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
Correct 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

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Q:15
Diagnosis of bacterial vaginosis by microscopy of vaginal discharge is supported
by all of the following, EXCEPT:
A: Absence of lactobacilli
B: Presence of clue cells
C: Abundance of polymorphs
D: Abundance of gram positive coccobacilli
Correct Ans:C
Explanation
Microscopy in bacterial vaginosis shows:
Clue cells in wet mount
Decreased number of lactobacilli
Increased number of gardnerella vaginalis
POLYMORHS ARE CONSPICUOUSLY ABSENT
Ref: GYNECOLOGICAL DIAGNOSIS
Shaw 15 th edition page: 131­132.
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Q:16
A 20 year old female presented with vaginal discharge which is non irritating and
malodorous. Saline wet preparation reveals clue cells. Clue cells are used to
detect which type of vaginitis?
A: Bacterial vaginosis
B: Candidal vaginitis
C: Primary syphilis
D: Secondary syphilis
Correct Ans:A
Explanation
Clue cells are the most reliable indicators of 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.
Must know:
Clinical diagnostic criteria for bacterial vaginosis:
Microscopic evaluation of a vaginal­secretion saline preparation

9. Release of volatile amines produced by anaerobic metabolism
Determination of the vaginal pH
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.
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Q:17
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
Correct 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 so­called "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.
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Q:18
A 24 year old female with multiple sex partners presented with vaginal discharge
which is thin and white with fishy odor. Whiff test is positive which indicates the
infection with which of the following organism?
A: TORCH
B: HIV
C: Bacterial vaginosis

10. D: Birth anoxia
Correct Ans:C
Explanation
Whiff test is positive for bacterial vaginosis. It involves the production of a fishy odor
when mixing vaginal fluid with 10% potassium hydroxide.
Amstel criteria for diagnosing BV:
Three of the following four must be present.
Thin, homogenous vaginal discharge
A positive whiff test
Vaginal fluid pH greater than 4.5
Presence of clue cells (epithelial cells covered with bacteria) on microscopic
examination
Ref: Rosen T. (2012). Chapter 205. Gonorrhea, Mycoplasma, and Vaginosis. In L.A.
Goldsmith, S.I. Katz, B.A. Gilchrest, A.S. Paller, D.J. Leffell, N.A. Dallas (Eds),
Fitzpatrick's Dermatology in General Medicine, 8e.
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Q:19 Clue cell is seen in?
A: Bacterial vaginosis
B: Candida
C: Trichomonas vaginalis
D: Condylomatous warts
Correct Ans:A
Explanation
Essentials of Diagnosis for Bacterial Vaginosis:
Homogeneous vaginal discharge
Amine (fishy) odor when potassium hydroxide solution is added to vaginal
secretions (commonly called the "whiff test").
Presence of clue cells (>20% of epithelial cells) on microscopy. 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.
Vaginal pH >4.5
Decrease in lactobacillus, small gram­variable rods, or curved gram­variable rods
in gram­stained smear.
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.

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Q:20
A pregnant female presented with itching in genital area. What is the MOST
common vaginal infection in pregnancy?Gonorrhoea z
A: Gonorrhoea
B: Trichomoniasis
C: Candidiasis
D: Bacterial vaginosis
Correct Ans:C
Explanation
Candida species are normal flora of the oropharynx, bowel, and vagina. Candida
overgrowth of these surfaces may arise in the setting of broad spectrum antibiotics,
diabetes mellitus, or HIV infection, resulting in oral thrush, Candida esophagitis, and
vaginal candidiasis. High estrogen states, such as pregnancy or oral contraceptive use,
are an additional risk factor for vaginal yeast infection. Candida skin infections are
often seen in moist, macerated intertrigenous folds, such as in the groin, perineum
(diaper rash), pannus, axillae, and breasts. Ref: Matloff J. (2012). Chapter 192.
Candida and Aspergillus. In G.V. Lawry, S.C. McKean, J. Matloff, J.J. Ross, D.D.
Dressler, D.J. Brotman, J.S. Ginsberg (Eds), Principles and Practice of Hospital
Medicine.
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Q:21 A lady presented with features of threatened abortion at 32 weeks of pregnancy.
Which of the following statements with regard to antibiotic usage is not correct?
A: Antibiotic Prophylaxis even with unruptured membranes
B: Metronidazole if asymptomatic but significant bacterial vaginosis
C: Antibiotics if asymptomatic but significant bacteremia
D: Antibiotics for Preterm Premature Rupture of Membranes
Correct Ans:A
Explanation
The lady in the question at 32weeks of gestation with features of threatened abortion
such as closed cervical os, intact membranes and without expulsion of products of
conception is in preterm labor. Since, threatened abortion is said to occur before
22weeks of gestation.
There is no benefit from the use of antibiotics for prevention of preterm labour in a
women with intact membrane.
Antibiotics along with other measures are used to prevent and treat preterm labour,
especially in the setting of chorioamnionitis which occur in case of ruptured membrane.
Ref: Danforth's Obstetrics and Gynecology, 10th Edition, Pages 169, 170, 171, 172;
Blueprints Obstetrics and Gynecology, 5th Edition, Page 108; William's Obstetrics, 23rd

12. Edition, Page 163; COGDT, 10th Edition, Pages 281, 278
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Q:22 One of the following is the MOST common vaginal infection during pregnancy:
A: Gonorrhea
B: Trichomoniasis
C: Bacterial vaginosis
D: Candidiasis
Correct Ans:D
Explanation
Most common vaginal infections during pregnancy is candidiasis. Growth of candida is
favoured by the high acid pH of vaginal secretions and frequent passage of sugar in the
urine during pregnancy. It is more prevalent in diabetic pregnancy.
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Q:23 Which of the following genital infections is associated with preterm labour ?
A: Human papilloma virus
B: Trichmonas vaginitis
C: Monilial vaginitis
D: Bacterial vaginosis
Correct Ans:D
Explanation
Bacterial vaginosis
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Q:24 Most common vaginal infection in pregnancy is?
A: Gonorrhea
B: Trichomoniasis
C: Candidiasis
D: Bacterial vaginosis
Correct Ans:C
Explanation

13. Candidiasis REF: http://www.cdc.gov/std/bv.stdfact­bacterial­vaginosis.htm
Most common vaginal infections during pregnancy is candidiasis
Bacterial vaginosis (BV) is the most common vaginal infection in women of
childbearing age
Genital human papillomavirus (also called HPV) is the most common sexually
transmitted infection (STI)
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Q:25 Clue cells are seen in?
A: Bacterial vaginosis
B: Herpes virus
C: Syphilis
D: Toxoplasmosis
Correct Ans:A
Explanation
Bacterial vaginosis REF: Shaw 13th ed p. 129, Novak's Gynecology 12th edition p. 192
Indirect repeat from June 2010
"Clue cells are seen in bacterial vaginosis"
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,
amine­like odor.
Culture of G. vaginalis is not recommended as a diagnostic tool because of its
lack of specificity.
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Q:26
A 16­year­old female comes to the physician because of an increased vaginal
discharge. She developed this symptom 2 days ago. She also complains of
dysuriA. She is sexually active with one partner and uses condoms
intermittently. Examination reveals some erythema of the cervix but is
otherwise unremarkable. A urine culture is sent which comes back negative.
Sexually transmitted disease testing is performed and the patient is found to

14. have gonorrheA. While treating this patient's gonorrhea infection, treatment
must also be given for which of the following?
A: Bacterial vaginosis
B: Chlamydia
C: Herpes
D: Syphilis
Correct Ans:B
Explanation
This patient has a gonorrhea infection.It is more common in patients of lower
socioeconomic status, patients with multiple sexual partners, and in urban settings.
The causative organism is N. gonorrhoeae, a gram­negative aerobic diplococcus. Up to
80% of women that are infected with the organism will have no symptoms at all or
only vague symptoms. Symptoms that are frequently noted are vaginal discharge,
postcoital spotting, and urinary symptoms if the urethra is involved. Examination may
reveal a cervicitis, although this is not always present. A patient found to have
gonorrhea should be treated with intramuscular ceftriaxone or oral cefixime,
ofloxacin, or ciprofloxacin. These medications will ffectively eradicate the gonococcus.
However, because Chlamydia trachomatis can be isolated in up to 50% of women with
gonorrhea and because women treated for gonorrhea only may soon go on to develop
Chlamydia or pelvic inflammatory disease (PID., any woman receiving treatment for
gonorrhea should also be treated for ChlamydiA. Treatment of Chlamydia is with
azithromycin or doxycycline. It is also essential that this patient's partner be treated as
well. When treating a patient for gonorrhea, there is no need to treat the patient with
metronidazole to treat bacterial vaginosis (Choice A) as well, unless there is evidence
of a bacterial vaginosis . Herpes (Choice C) often presents as painful vesicles and
ulcers. Patients with onorrhea do not need to be treated for herpes as well, unless
there is evidence for herpes infection. Patients with gonorrhea are at increased risk of
having other sexually transmitted diseases, including syphilis (Choice D). It would be
prudent to check this patient for syphilis with a blood test. However, in the absence of
a positive syphilis test, patients with gonorrhea do not need to be treated for syphilis.
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Q:27
A 16­year­old female comes to the physician because of an increased vaginal
discharge. She developed this symptom 2 days ago. She also complains of
dysuria. She is sexually active with one partner and uses condoms
intermittently. Examination reveals some erythema of the cervix but is
otherwise unremarkable. A urine culture is sent which comes back negative.
Sexually transmitted disease testing is performed and the patient is found to
have gonorrhea. While treating this patient's gonorrhea infection, treatment
must also be given for which of the following?
A: Bacterial vaginosis
B: Chlamydia
C: Herpes

15. D: Syphilis
Correct Ans:B
Explanation
This patient has a gonorrhea infection. It is more common in patients of lower
socioeconomic status, patients with multiple sexual partners, and in urban settings.
The causative organism is N. gonorrhoeae, a gram­negative aerobic diplococcus. Up to
80% of women that are infected with the organism will have no symptoms at all or
only vague symptoms. Symptoms that are frequently noted are vaginal discharge,
postcoital spotting, and urinary symptoms if the urethra is involved. Examination may
reveal a cervicitis, although this is not always present. A patient found to have
gonorrhea should be treated with intramuscular ceftriaxone or oral cefixime,
ofloxacin, or ciprofloxacin. These medications will effectively eradicate the
gonococcus. However, because Chlamydia trachomatis can be isolated in up to 50% of
women with gonorrhea and because women treated for gonorrhea only may soon go
on to develop Chlamydia or pelvic inflammatory disease (PID), any woman receiving
treatment for gonorrhea should also be treated for Chlamydia. Treatment of
Chlamydia is with azithromycin or doxycycline. It is alsoessential that this patient's
partner be treated as well. When treating a patient for gonorrhea, there is no need to
treat the patient with metronidazole to treat bacterial vaginosis as well, unless there is
evidence of a bacterial vaginosis. Herpes often presents as painful vesicles and ulcers.
Patients with ameonorrhea do not need to be treated for herpes as well, unless there is
evidence for herpes infection. Patients with gonorrhea are at increased risk of having
other sexually transmitted diseases, including syphilis. It would be prudent to check
this patient for syphilis with a blood test. However, in the absence of a positive syphilis
test, patients with gonorrhea do not need to be treated for syphilis.
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Q:28 Bacterial vaginosis does not include?
A: Profuse creamy discharge
B: Clue cells present
C: Positive whiff test
D: Absent leucocytes
Correct 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,

16. 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,
amine­like odor.
Culture of G. vaginalis is not recommended as a diagnostic tool because of its
lack of specificity.
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Q:29 Koilocytes with perinuclear halo on pap smear is pathognomic of?
A: HPV infection
B: Metaplasia
C: Dysplasia
D: Bacterial vaginosis
Correct Ans:A
Explanation
HPV infection REF: Shaw's Gynecology 13th ed p­ 78, The pap test by Richard M.
DeMay page 49­50
"Koilocytes, dyskeratocytes, macrocytes, etc. are some of the cytologic findings that
are characteristic of condylomas (HPV). Koilocytes with perinuclear halo is
pathognomonic of HPV infection"
Condition Type of cell
Estrogen dominated uterus Normal cornified cells
Progesterone dominated uterus Intermediate cells
pregnancy Intermediate cells , Navicular cells
menopausal Basal , parabasal
HPV Koilocytes, dyskeratocytes,
macrocytes
with perinuclear halo.
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Q:30 "Whiff" Test is done for:
A: Bacterial vaginosis
B: Trichomonas
C: Candida
D: Gonorrhoea

17. Correct Ans:A
Explanation
Bacterial vaginosis
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Q:31 Clue cells are found in:
A: Bacterial vaginosis
B: Chlamydia trachomatis
C: Neisseria gonorrhoea
D: Trichoomonas
Correct Ans:A
Explanation
Bacterial vaginosis
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