Medical analysis

Student one example. The woman in this scenario is presenting with bacterial vaginosis (BV). With BV the vaginal discharge pH shows low acidity and is typically greater than 4.5. Other signs of BV include a milky discharge and a fishy odor. Trichomonas also includes an unpleasant odor, however the discharge with trich is a yellowish or greenish color. To distinguish between trich and BV a clinician would perform a pelvic exam, gram stain and pH testing, none of which are fasting tests. A clinician will evaluate a number of factors that could lead to BV including last menstrual period, number of sexual partners, history of sexually transmitted diseases or urinary tract infections, method of contraception, pregnancy history, use of douche, tampons, and vaginal deodorants or whether the patient wears tight undergarments. (Bacterial vaginosis, 2010). The most common medication prescribed for BV is metronidazole (Flagyl) and it is important to instruct the patient not to drink while on this medication due to the reaction the patient may experience when combining Flagyl with alcohol. Seven days of treatment with oral metronidazole or five days of treatment with metronidazole vaginal get are equally effective. Another medication used for treatment of BV is clindamycin (Cleocin) vaginal cream, however clindamycin is shown to be less effective. (Cleveland clinic, 2015). Cleveland Clinic. (2015). Bacterial vaginosis (BV). Retrieved from: http://my.clevelandclinic.org/health/articles/bacterial-vaginosis Bacterial vaginosis (gardnerella vaginitis). (2010). Boston: Harvard Health Publications. Retrieved from http://prx-herzing.lirn.net/login?url=http://search.proquest.com.prx-herzing.lirn.net/docview/1370739417?accountid=167104 Student two example “Vaginitis with discharge can result from Candida, Trichomonas vaginalis, bacterial vaginosis. Diagnosis depends on laboratory tests because sensitivity and specificity of discharge characteristics are low” (Bickley, 2013, p. 560). History from the patient including complaints of pruritus or antibiotic use is beneficial. The history she has provided is helpful, being in a monogamous relationship, but as we all know it is still important to perform testing which includes the STI’s. She may be monogamous, but the dirty rotten scoundrel of a husband may not be. It is also beneficial to know whether there is itching, or if she has used antibiotics in the recent past. Antibiotic use can throw off the vaginal flora which would be more indicative of BV, whereas pruritis is more indicative of trichomonas. She may have both trichomonas and BV. Candida albicans overgrowth is not malodorous. Specifically, bacterial vaginosis may have an unpleasant fishy or musty odor. (Bickley, 2013, table 14-2). Also, noting any trouble with urination is helpful. With complaints of vaginal discharge, it may be necessary to perform a urinalysis and a pelvic exam to obtain a swab of the discharge. To rule in/out trichomonas or BV a scan saline wet mount for trichomonas and for clue cells (epithelial cells with stippled borders) is one laboratory test. (Bickley, 2013, table 14-2) The addition of potassium hydroxide, KOH, will increase the fishy odor smell of BV, after the “whiff” test. (Dains, Baumann, & Scheibel, 2016). These laboratory tests do not warrant fasting or NPO. Or, she may have neither of these and may have simply forgotten to remove a tampon or has some other foreign body, seeing that “the presenting symptom in foreign body retention is a very malodorous, whitish discharge” (Dains et al., 2016, p. 442). It has been indicated that “diagnosis is best established by measuring the pH of the discharge, performing the whiff test, and using microscopic examination” (Dains et al., 2016, p. 441). Normal physiological discharge has a pH less than 4.5, bacterial vaginosis the pH is greater than 4.5 and trichomoniasis the pH is greater than 5, along with any other microscopic findings. (Dains et al., 2016, p. 441) My scoundrel comment regarding the husband is hopefully taken as humor, seeing that with any medical issue, anybody can lie. As much as we like to give everyone the benefit of the doubt, it can come back to bite us. History and physical examination, along with laboratory testing can help in the final diagnosis. References Bickley, L. (2013). Bates' guide to physical examination and history taking (11th ed.). [Vitalbook]. Retrieved from https://bookshelf.vitalsource.com/books/9781469825106 Dains, J. E., Baumann, L. C., & Scheibel, P. (2016). Advanced health assessement and clincial diagnosis in primary care (5th ed.). St. Louis, MO: Elsevier. Student three example A differential diagnosis of bacterial vaginosis (BV) with typical symptoms been vaginal discharge often white-grey in color with often a characteristic fishy smell. In addition, since this patient is irregular, monogamous relationship, do not indicate a sexual transmitted infectious disease but an overgrowth of various bacteria in the vagina. Bacterial vaginosis is not caused by poor hygiene (National Health Services [NHS], 2017]. Another differential diagnosis could be Trichomoniasis, which is a sexual transmitted infection (STI), caused by tiny parasite and presents signs as frothy yellow or green vaginal discharge which may have an unpleasant fishy smell. However, Trichomoniasis also presents others signs as soreness, swelling and itching around the vagina and pain during urination (NHS, 2017). Testing for bacterial vaginosis and Trichomoniasis can be performed right in the primary provider office and require no pre-procedure preparation or post-procedure care and management. The tests are composed by checking vaginal pH in office and obtaining a couple of samples (swabs) from the vaginal wall and discharge to be sent to the laboratory for further culture and sensitivity test. The vaginal discharge pH level testing is that the overgrowth of bacterial vaginosis causes a typical alkaline pH level (pH rises) compared to other causes of discharge which causes it characteristic fishy smell. In addition, the laboratory testing will show if there are a large numbers of various bacteria common in bacterial vaginosis or Trichomoniasis (NHS, 2017; NHS 2017). After obtaining samples, both bacterial vaginosis and Trichomoniasis can be treated with metronidazole 250 mg three times a day, for seven days (RxList, 2017). However, if Trichomoniasis is highly suspected, the patient and sexual partner(s) should be treated together to prevent reinfection (NHS, 2017). References RxList. (2017). Flagyl. Retrieved from http://www.rxlist.com/flagyl-drug/indications-dosage.htm National Health Services [NHS]. (2017). Bacterial vaginosis. Retrieved from http://www.nhs.uk/conditions/bacterialvaginosis/pages/introduction.aspx