QUESTION: 183

A wet smear of a vaginal discharge is illustrated in Figure.Which of the following is the most likely cause of the discharge?

monilial vaginitis
trichomonas vaginitis
Chlamydia trachomatis
N. gonorrhoeae
bacterial vaginosis

Answer(s): E

Explanation:

Clue cells are shown in Figure. This indicates bacterial vaginosis. Clue cells are vaginal squamous cells with indistinct margins that are studded extensively with coccobacilli. Trichomonas infection is caused by a unicellular protozoon. The organism on wet smear with normal saline is fusiform, slightly larger than white blood cells, and has flagella at one end.
The flagella cause the motion on wet smear that is diagnostic. Monilial vaginitis is best demonstrated by placing a small amount of the discharge in 10% KOH and observing for branching hyphae. N. gonorrhoeae and C. trachomatis cannot be seen on a wet smear.

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QUESTION: 184

A wet smear of a vaginal discharge is illustrated in Figure.Which of the following is the most likely cause of the discharge?

Which of the following is the most appropriate treatment for the discharge illustrated in Figure?

clindamycin
erythromycin
metronidazole
miconazole
doxycycline

Answer(s): C

Explanation:

The treatment of choice for bacterial vaginosis is metronidazole, also an effective treatment for trichomonas vaginitis. The dose is 375500 mg orally twice daily for 1 week. A single daily dose of 750 mg was recently approved. Vaginal metronidazole gel or clindamycin cream are also approved forms of treatment. Concurrent therapy of the male partner is controversial. Treatment in pregnancy is recommended, because there is a potential association of bacterial vaginosis and preterm labor and delivery.

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QUESTION: 185

A 37-year-old man and his wife seek help for their 5-year history of primary infertility. Her infertility investigation is normal. However, the husband has an ejaculate volume of 0.4 mL, and there are no sperm in the ejaculate. Aqualitative test for fructose in the semen is negative. Which of the following is the most likely diagnosis?

germ cell aplasia
bilateral occlusion of the vasa deferentia
17-hydroxylase deficiency
congenital absence of the vasa deferentia
Klinefelter syndrome

Answer(s): D

Explanation:

The normal ejaculate volume is 25 mL, and the bulk of the ejaculate is from the seminal vesicles. The reduced ejaculate volume may be the result of an incomplete collection or may indicate absence of the seminal vesicles. Fructose is the reducing sugar produced by the seminal vesicles, and its absence establishes a diagnosis of congenital bilateral absence of the vasa deferentia and seminal vesicles. This explains the azoospermia (absence of sperm; aspermia is absence of an ejaculate). Men with germ cell aplasia have only Sertoli cells in their seminiferous tubules. Their ejaculate volumes are normal, and fructose is present. Likewise, men with occlusion of the vasa deferentia will be azoospermic but have a normal ejaculate volume containing fructose. Men with 17- hydroxylase deficiency will have hypertension, be sexually infantile, and have azoospermia, because the enzyme deficiency prevents the secretion of normal amounts of cortisol, androgens, and estrogen, but an increased secretion of mineralocorticoids.
Men with Klinefelter syndrome have patent vasa deferentia and seminal vesicles; their ejaculate volumes will be normal and contain fructose.

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QUESTION: 186

A healthy 27-year-old male and his partner have been attempting to conceive for more than 1 year. As part of their evaluation he has a semen analysis. His ejaculate volume is 3.5 mL, sperm concentration is 8 million/mL, sperm motility is 65%, oval forms comprise 60% of the sperm, and fructose is present in the ejaculate. Which of these semen parameters is abnormal and suggests that this couple's infertility may be due to a male factor?

ejaculate volume
sperm concentration
sperm motility
sperm morphology
presence of fructose

Answer(s): B

Explanation:

The WHO suggests a minimal sperm concentration of 20 million/mL for normal conception rates of 1520% per ovulation. However, sperm motility (percentage and velocity; >50% with forward progression), sperm morphology (30% or more oval forms, using strict criteria), coital frequency, and others must be considered. Stated otherwise, a sperm concentration of 10 million/mL may be associated with normal fertility if the sperm motility and morphology are better than average and coital frequency is three to four times per week. Any abnormality of a semen analysis should be confirmed by a repeat semen analysis no sooner than 4 weeks after the initial analysis.

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QUESTION: 183

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QUESTION: 184

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QUESTION: 185

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QUESTION: 186

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