& x20;A female presents with greenish frothy discharge; whiff test and Amsel’s criteria are negative. What mi… - INI-CET EXAM -2026

INI-CET EXAM -2026

Obstetrics & Gynaecology

Medium

Appeared in: INI-CET EXAM -2026

Explanation

The patient's symptom of greenish, frothy discharge is a hallmark clinical sign of trichomoniasis.
The diagnosis of trichomoniasis is confirmed by observing motile, flagellated protozoa on a wet-mount microscopy slide of the vaginal discharge.
The negative whiff test and Amsel's criteria are provided to specifically rule out bacterial vaginosis, making other options less likely.

Option B: Pseudohyphae are characteristic of a fungal infection, specifically candidiasis (yeast infection). This condition typically presents with a thick, white, curd-like (cottage cheese) discharge, not a greenish, frothy one.
Option C: Clue cells are the hallmark of bacterial vaginosis (BV). The question explicitly states that Amsel's criteria and the whiff test are negative. Since clue cells are a key component of Amsel's criteria for diagnosing BV, their presence is ruled out by the information given.
Option D: Intracellular gram-negative diplococci are the characteristic microscopic finding for Neisseria gonorrhoeae infection. While gonorrhea can cause vaginal discharge, it is typically purulent or mucopurulent and originates from the cervix (cervicitis), rather than the classic frothy vaginal discharge described.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Differential diagnosis of vaginitis based on clinical presentation and microscopic findings as background academic context rather than a clinical decision trigger.
Accurate diagnosis of vaginitis is crucial for appropriate treatment. Using the wrong medication (e.g., an antifungal for trichomoniasis) will be ineffective and can lead to persistent symptoms and patient discomfort.
Trichomoniasis is a sexually transmitted infection (STI). A diagnosis requires patient counseling on safe sex practices and the importance of partner notification and treatment to prevent reinfection and further spread.
What if the whiff test was positive? A positive whiff test (a fishy odor upon adding KOH) would strongly suggest bacterial vaginosis, making 'Clue cells' the most likely answer, even with a frothy discharge (as co-infections can occur).

How to Approach the Question

First, identify the key clinical features in the stem: 'greenish frothy discharge'. This is a classic description.
Next, analyze the negative findings: 'whiff test and Amsel’s criteria are negative'. Understand what these tests are for (Bacterial Vaginosis) and what their negative result implies (BV is unlikely).
Correlate the primary clinical sign with its known cause. 'Greenish frothy discharge' strongly points to Trichomoniasis.
Recall or look up the specific microscopic finding for Trichomoniasis.
Evaluate the options: 'Motile flagellates' is the microscopic feature of Trichomonas vaginalis.
Eliminate the other options based on the information. 'Clue cells' are ruled out by the negative BV tests. 'Pseudohyphae' and 'gram-negative diplococci' are associated with different clinical presentations (candidiasis and gonorrhea, respectively).

Concept Tested & Keywords

Concept Tested: Differential diagnosis of vaginitis based on clinical presentation and microscopic findings.
Stem keywords: greenish frothy discharge, whiff test negative, Amsel’s criteria negative, microscopy
Lead-in keywords: What
Clinical cues: The combination of 'greenish frothy discharge' with negative results for bacterial vaginosis tests is a strong pointer towards trichomoniasis.

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

E6 Gynecology Williams p. 62-85