MCN 538 UPDATED FINAL PAPER QUESTIONS AND
ANSWERS GRADED A+
✔✔What factors Influence Menopause? - ✔✔Smoking, higher parity, body mass,
malnourishment, vegetarianism, ethnicity
✔✔what are effects of menopause on CNS, Bones, GU, Metabolic system, and the
cardiovascular system? - ✔✔CNS: vasomotor instability, sleep disruption, cognitive
decline; Skin: loss of collagen (first 5 yrs); Bone: estrogen deficiency causes bone loss;
GU: vulvovaginal symptoms & urinary complaints; Metabolic: decreased carbohydrate
tolerance, increased insulin resistance; CVD risk rises
✔✔is postmenopausal Vaginal Bleeding acceptable? - ✔✔no! it is a Red flag; must be
investigated for endometrial cancer
✔✔what are some common General Health Concerns in Mature Women - ✔✔Age-
related physiologic changes affect disease processes; cognitive decline and dementia;
review adolescent & adult concerns for relevance
✔✔what is vaginitis? - ✔✔Inflammation or infection of the vagina; common presenting
complaints include itching, burning, irritation, dyspareunia, fishy odor, abnormal
discharge
✔✔what are common Causes of Vaginitis? - ✔✔Vulvovaginal candidiasis (17-39%),
bacterial vaginosis (22-50%), Trichomoniasis (4-35%); may remain undiagnosed in 7-
72% of patients
✔✔what is Estrogen's role in the vaginal environment? - ✔✔Estrogen increases
glycogen in epithelial cells → lactobacilli colonization → lactic acid → vaginal pH <4.5,
discouraging pathogenic growth. this is protective and good!
✔✔what bacterium is included in Normal Vaginal Flora? - ✔✔Gardnerella vaginalis, E.
coli, GBS, genital mycoplasma species, Candida albicans
✔✔what is BV Pathophysiology? - ✔✔Overgrowth of facultative anaerobes, lack of
H2O2-producing lactobacilli; not single pathogen STI; associated with aging, douching,
sexual activity; many asymptomatic
✔✔what are Symptoms of BV? - ✔✔Abnormal vaginal discharge, fishy odor after
intercourse or menses
✔✔what are the risk factors for and symptoms of trichomonas vaginalis? - ✔✔risk
factors: multiple sex partners, low SES, douching; associated with PID, post-
, hysterectomy cuff cellulitis, HIV, other STIs; 50% asymptomatic; symptoms: discharge,
itching, burning, postcoital bleeding
✔✔what is Vulvovaginal Candidiasis? what are the symptoms? - ✔✔Inflammation &
infection with Candida spp.; second most common cause; range: asymptomatic to
severe (burning, itching, edema, dysuria, dyspareunia, abnormal discharge); uncommon
in prepubertal & postmenopausal women not on estrogen
✔✔Clinical Evaluation of Vaginitis should include what? - ✔✔History: sexual, OTC/Rx
use, hygiene, underlying conditions, relation to menstrual cycle; Physical: vulva &
vagina; Clinical testing: pH, KOH whiff, saline & KOH microscopy; FDA tests if needed
✔✔Normal Vaginal Discharge should be what colors, what ph, and what bacteria should
dominate? - ✔✔White & creamy or clear; pH 3.5-4.5; dominated by lactobacillus
✔✔how is BV diagnosed? - ✔✔Amsel criteria: 3 of 4 needed → homogenous thin
discharge, >20% clue cells, pH>4.5, positive KOH whiff; Gram stain with Nugent scoring
alternative
✔✔how is BV Treated? - ✔✔Metronidazole 500mg PO BID x7d or 2g single dose for
men; Metronidazole gel 0.75% intravaginally daily x5d; Clindamycin 2% cream
intravaginally x7d; Abstain from alcohol during & 24h after metronidazole; Treat partner,
retest at <3 months
✔✔how is Trichomoniasis vaginalis dx? - ✔✔Motile trichomonads on microscopy,
pH>4.5, abundant PMNs, yellow-green frothy discharge, vaginal/cervical erythema
✔✔how is Vulvovaginal Candidiasis Diagnosed? - ✔✔Visualization of spores, pseudo
hyphae, or hyphae on wet mount; fungal culture or commercial test if microscopy
negative; C. albicans 90% cases
✔✔how is Vulvovaginal Candidiasis Classified? - ✔✔Uncomplicated: sporadic,
mild/moderate, C. albicans, non-immunocompromised; Complicated: recurrent ≥4/yr,
severe, non-C. albicans, diabetes, immunocompromised
✔✔what is the treatment for Vulvovaginal Candidiasis? - ✔✔Uncomplicated:
intravaginal azoles or oral fluconazole; Complicated: culture & susceptibility testing,
suppressive therapy weekly or intermittent; Severe: topical intravaginal azole 10-14d or
oral fluconazole 2-3 doses 3 days apart; Non-albicans: intravaginal boric acid 600mg
daily ≥14d; refer if ineffective
✔✔Vaginitis Caveats include: - ✔✔Exam before treatment; self-diagnosis not
recommended; failure of OTC = evaluation; PAP not reliable for dx; probiotics not
recommended for treatment or prevention; sex partner treatment not needed for BV or
uncomplicated candidiasis
ANSWERS GRADED A+
✔✔What factors Influence Menopause? - ✔✔Smoking, higher parity, body mass,
malnourishment, vegetarianism, ethnicity
✔✔what are effects of menopause on CNS, Bones, GU, Metabolic system, and the
cardiovascular system? - ✔✔CNS: vasomotor instability, sleep disruption, cognitive
decline; Skin: loss of collagen (first 5 yrs); Bone: estrogen deficiency causes bone loss;
GU: vulvovaginal symptoms & urinary complaints; Metabolic: decreased carbohydrate
tolerance, increased insulin resistance; CVD risk rises
✔✔is postmenopausal Vaginal Bleeding acceptable? - ✔✔no! it is a Red flag; must be
investigated for endometrial cancer
✔✔what are some common General Health Concerns in Mature Women - ✔✔Age-
related physiologic changes affect disease processes; cognitive decline and dementia;
review adolescent & adult concerns for relevance
✔✔what is vaginitis? - ✔✔Inflammation or infection of the vagina; common presenting
complaints include itching, burning, irritation, dyspareunia, fishy odor, abnormal
discharge
✔✔what are common Causes of Vaginitis? - ✔✔Vulvovaginal candidiasis (17-39%),
bacterial vaginosis (22-50%), Trichomoniasis (4-35%); may remain undiagnosed in 7-
72% of patients
✔✔what is Estrogen's role in the vaginal environment? - ✔✔Estrogen increases
glycogen in epithelial cells → lactobacilli colonization → lactic acid → vaginal pH <4.5,
discouraging pathogenic growth. this is protective and good!
✔✔what bacterium is included in Normal Vaginal Flora? - ✔✔Gardnerella vaginalis, E.
coli, GBS, genital mycoplasma species, Candida albicans
✔✔what is BV Pathophysiology? - ✔✔Overgrowth of facultative anaerobes, lack of
H2O2-producing lactobacilli; not single pathogen STI; associated with aging, douching,
sexual activity; many asymptomatic
✔✔what are Symptoms of BV? - ✔✔Abnormal vaginal discharge, fishy odor after
intercourse or menses
✔✔what are the risk factors for and symptoms of trichomonas vaginalis? - ✔✔risk
factors: multiple sex partners, low SES, douching; associated with PID, post-
, hysterectomy cuff cellulitis, HIV, other STIs; 50% asymptomatic; symptoms: discharge,
itching, burning, postcoital bleeding
✔✔what is Vulvovaginal Candidiasis? what are the symptoms? - ✔✔Inflammation &
infection with Candida spp.; second most common cause; range: asymptomatic to
severe (burning, itching, edema, dysuria, dyspareunia, abnormal discharge); uncommon
in prepubertal & postmenopausal women not on estrogen
✔✔Clinical Evaluation of Vaginitis should include what? - ✔✔History: sexual, OTC/Rx
use, hygiene, underlying conditions, relation to menstrual cycle; Physical: vulva &
vagina; Clinical testing: pH, KOH whiff, saline & KOH microscopy; FDA tests if needed
✔✔Normal Vaginal Discharge should be what colors, what ph, and what bacteria should
dominate? - ✔✔White & creamy or clear; pH 3.5-4.5; dominated by lactobacillus
✔✔how is BV diagnosed? - ✔✔Amsel criteria: 3 of 4 needed → homogenous thin
discharge, >20% clue cells, pH>4.5, positive KOH whiff; Gram stain with Nugent scoring
alternative
✔✔how is BV Treated? - ✔✔Metronidazole 500mg PO BID x7d or 2g single dose for
men; Metronidazole gel 0.75% intravaginally daily x5d; Clindamycin 2% cream
intravaginally x7d; Abstain from alcohol during & 24h after metronidazole; Treat partner,
retest at <3 months
✔✔how is Trichomoniasis vaginalis dx? - ✔✔Motile trichomonads on microscopy,
pH>4.5, abundant PMNs, yellow-green frothy discharge, vaginal/cervical erythema
✔✔how is Vulvovaginal Candidiasis Diagnosed? - ✔✔Visualization of spores, pseudo
hyphae, or hyphae on wet mount; fungal culture or commercial test if microscopy
negative; C. albicans 90% cases
✔✔how is Vulvovaginal Candidiasis Classified? - ✔✔Uncomplicated: sporadic,
mild/moderate, C. albicans, non-immunocompromised; Complicated: recurrent ≥4/yr,
severe, non-C. albicans, diabetes, immunocompromised
✔✔what is the treatment for Vulvovaginal Candidiasis? - ✔✔Uncomplicated:
intravaginal azoles or oral fluconazole; Complicated: culture & susceptibility testing,
suppressive therapy weekly or intermittent; Severe: topical intravaginal azole 10-14d or
oral fluconazole 2-3 doses 3 days apart; Non-albicans: intravaginal boric acid 600mg
daily ≥14d; refer if ineffective
✔✔Vaginitis Caveats include: - ✔✔Exam before treatment; self-diagnosis not
recommended; failure of OTC = evaluation; PAP not reliable for dx; probiotics not
recommended for treatment or prevention; sex partner treatment not needed for BV or
uncomplicated candidiasis
