Whiff test is done in:
Correct Answer: Bacterial vaginosis
Description: Ref: Shaw's Textbook of Gynecology 15th edition pg.131Explanation:GARDNERELLA VAGINOSISAlteration in normal vaginal floraDecrease in number of lactobacilli in vaginal discharge - lactobacilli reduce pH and release hydrogen peroxide toxic to other bacteriaFETAL SKULL DIAMETERBORDERSLENGTHSuboccipito-bregmaticFrom nape of neck to center of bregma9.5cmSuboccipito-fronta1From nape of neck to anterior fontanelle or center of sinciput1 0cmOccipito-frontalFrom occipital eminence to root of nose11.5 cmMentovertical-From midpoint of chin to highest point of sagittal suture14cmSubmentoverticalFrom junction of floor of the mouth and neck to highest point of sagittal suttre11.5 cmSubmentobregmaticFrom junction of mouth and neck to center of bregma9.5cmBiparietalExtends between two parietal eminences9.5cmSuper sub-parietalFrom a point placed below one parietal eminence to a point placed above the other parietal eminence on opposite side8.5cmBitemporaldistance between two anteri or ends of coronal sutire8cmBimastoidDistance between tips of mastoid processes7.5cm100 fold increase in anerobic bacteriaHemophilus vaginalis, Gardnerella, Mobiluncus and Mycoplasma hominis--causeVaginal discharge without dischargeWhite , milky non-viscous discharge, pH of discharge more than 4.5Whiff Test - Fishy odour when vaginal discharge is mixed with 10% KOH - due to release of amino metabolites from various organismsPresence of Clue Cells - epithelial cells with granular cytoplasm caused by gram negative bacilli adhering on the surfaceWet smear, gram stain and culture are investigationsTreatment--Metronidazole 500mg bd for 7 daysAmpicillin 500mg or cephalosporin 500mg bd for 7 daysTetracycline 500mg 4 times a dayDoxycycline lOOmg hdSulphafurazole Ig 4 times daily for 10-14 daysClindamycin 300mg daily for 7 daysClindamycin 2% cream locallyOrnidazole 500mg vaginal tablet for 7 daysLacteal is protein free acidifying lactate gel neutralises vaginal ph 5ml applied for 7 daysAMSEL CRITERIA for diagnosing Bacterial VagninosisThin, white, yellow, homogeneous dischargeClue cells on microscopypH of vaginal fluid >4.5Release of a fishy odor on adding alkali--10% potassium hydroxide (KOH) solution.At least three of the four criteria should be present for a confirmed diagnosis.CANDIDIASISCandida albicansFlourishes in acidic mediumCommon in pregnancy , diabetes, OCP usersCurdy white dischargeIntense pruritisNot foul smelling10 % KOH mount - mycelia and budding sporesSabouraud's medium for cultureDOC- imidazoles - vagina pessaryOral fluconazole TRICHOMONIASISTrichomonas vaginalisGreenish yellow dischargeAssociated pruritisFoul smelling dischargeStraw berry vaginaDOC - Metronidazole
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Gynaecology & Obstetrics
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