A 35 years old lady visited the OPD with complaints of itching and discharge from the Vagina. The Nurse examines her and notices that there is 'curdy white' vaginal discharge which is indicate to?

1. A

   Gonorrhoea

2. B

   Bacterial Vaginitis

3. C

   Candida Infection

4. D

   Syphilis

Appeared in: RML Lucknow - 2021

Explanation

• The hallmark symptom of vulvovaginal candidiasis (a yeast infection) is a thick, white, 'curdy' or 'cottage cheese-like' vaginal discharge.
• This discharge is often accompanied by significant vulvar itching (pruritus), burning, and erythema (redness).
• Unlike bacterial vaginosis, the discharge from a Candida infection typically does not have a foul or fishy odor.
• The vaginal pH in candidiasis is usually normal, which is a pH of 4.5 or less.

Why Other Options Were Wrong

• Option A: Gonorrhoea typically causes a mucopurulent (pus-like) discharge originating from the cervix, not a curdy white vaginal discharge. It is often associated with cervicitis and can be asymptomatic in women.
• Option B: Bacterial Vaginosis (BV) is characterized by a thin, homogeneous, grayish-white discharge with a distinct 'fishy' odor, especially after intercourse (positive 'whiff test'). The discharge is not curdy.
• Option D: The primary stage of syphilis presents with a painless ulcer (chancre) at the site of infection. Vaginal discharge is not a typical feature of any stage of syphilis.

Related Visual

Clinical Relevance

• Nursing practice connection: Knowing Differential diagnosis of vaginitis based on clinical presentation helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
• A nurse's ability to accurately identify different types of vaginal discharge based on patient history and examination is crucial for initial triage, collecting appropriate specimens, and anticipating the correct treatment pathway.
• Patient education is a key nursing role. For candidiasis, this includes teaching about proper hygiene (e.g., wiping front to back), wearing cotton underwear, avoiding douching, and completing the full course of antifungal medication.
• Nurses should assess for risk factors for candidiasis, such as recent antibiotic use, uncontrolled diabetes, pregnancy, and immunosuppression.

How to Approach the Question

• First, analyze the patient's chief complaints: itching and vaginal discharge.
• Identify the most specific and descriptive clinical sign provided in the stem: the discharge is 'curdy white'.
• Recall the classic presentations of common causes of vaginitis.
• Match the 'curdy white' or 'cottage cheese-like' discharge to its corresponding diagnosis, which is Candida infection.
• Review the other options to confirm they do not fit the clinical picture. For example, bacterial vaginosis has a thin, fishy-smelling discharge, and syphilis presents with a chancre.
• Select the option that aligns with the pathognomonic sign presented in the question.

Concept Tested & Keywords

• Concept Tested: Differential diagnosis of vaginitis based on clinical presentation
• Stem keywords: itching, discharge from the Vagina, 'curdy white' vaginal discharge
• Lead-in keywords: indicate to
• Clinical cues: 'curdy white' vaginal discharge is a pathognomonic sign for vulvovaginal candidiasis.
• Negative lead-in flag: false

Question ID

QrNs80CZ57oc6BM-xRcl3e

Copy ID

Reference Book

E6 Medicine Davidson Principles Practice 24e p. 355-357

E6 Gynecology Williams p. 69-92