Clinical Expert Series
Management of Persistent Vaginitis
Paul Nyirjesy, MD
Obstet Gynecol 2014;124(6)
Continuing Medical Education credit is provided through joint sponsorship with
The American College of Obstetricians and Gynecologists.
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equivalent to College Cognate Credits.
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Submission
Before submitting this form, please print a completed copy as confirmation of your program participation.
College Fellows: To obtain credits, complete and return this form by e-mail (obgyn@greenjournal.org) or fax (202-479-0830).
Your score, and a copy of the answer key, will be e-mailed to you after receipt of a completed quiz. Credit will be recorded for
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Non–College Fellows: To obtain credits, submit the printout of the completed quiz to your accrediting institution. The printout of
the completed quiz is documentation for your continuing medical education credits.
Continuing medical education credit for “Management of Persistent Vaginitis” will be available through December 2017.
1. A heavy but normal physiologic discharge can be determined by:
Serum estrogen level
Vaginal bacterial culture
Symptom diary
Response to empiric progestin therapy
Excluding other causes
CME Quiz for the Clinical Expert Series
Obstet Gynecol 2014;124(6)
Credit available through December 2017
Page 1 of 3
2. An effective first choice for many true non-albicans Candida infections is:
Weekly oral fluconazole
Weekly vaginal clotrimazole
Vaginal boric acid
Vaginal pH elevation
High-dose tinidazole
3. Desquamative inflammatory vaginitis is generally associated with:
Non-albicans Candida infections
Metronidazole-resistant trichomoniasis
Hypoestrogenism
Chronic vaginal douching
Self-medication
4. For women whom have had symptoms for more than one year, Nyirjesy and colleagues found that
which of the following was the most common cause?
Localized provoked vestibulodynia
Physiologic discharge
Contact dermatitis
Atrophic vaginitis
Trichomoniasis
5. A patient with symptoms of vaginal discharge and itching is found to have a vaginal pH of 4.0.
Which of the following is the most likely diagnosis?
Bacterial vaginosis
Atrophic vaginitis
Vulvovaginal candidiasis
Trichomoniasis
Desquamative inflammatory vaginitis
6. If Trichomonas vaginalis infection is suspected, which of the following is the most reliable method of
establishing a diagnosis?
Office saline microscopy
Vaginal pH measurement
Polymerase chain reaction (PCR)
Office 10% KOH microscopy
Empiric therapy response
CME Quiz for the Clinical Expert Series
Obstet Gynecol 2014;124(6)
Credit available through December 2017
Page 2 of 3
7. The current definition of recurrent vulvovaginal disease includes:
Greater than four lifetime infections
Symptoms lasting greater than 6 weeks
Four or more episodes in a year
At least two different organisms on two occasions
Recurrence less than 4 weeks after therapy
8. The gold standard for the diagnosis of vulvovaginal candidiasis is:
Vaginal pH measurement
Polymerase chain reaction (PCR)
Yeast cultures with speciation of the organism
Office 10% KOH microscopy
Clinical examination
9. Which of the following is part of Amsel’s criteria for the diagnosis of bacterial vaginosis?
Thick white discharge
≥ 30 white blood cells per high power field on saline microscopy
A pH ≥ 4.5
Cocciform bacilli on Gram stain
Positive culture for Gardnerella vaginalis
10. A woman who has been using combination oral contraceptives for the past 8 years reports a vaginal
discharge described as yellow or brown, along with burning and severe dyspareunia. Examination
reveals severe introital and vaginal erythema and a copious vaginal discharge. A number of white
blood cells are seen on saline microscopy. The most likely explanation for this patient’s symptoms is:
Vulvovaginal candidiasis
Lichen sclerosus
Occult urinary incontinence
Bacterial vaginosis
Desquamative inflammatory vaginitis
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CME Quiz for the Clinical Expert Series
Obstet Gynecol 2014;124(6)
Credit available through December 2017
Page 3 of 3