02-15-2010, 07:16 PM
A 27-year-old woman comes to the office because she recently noted a copious vaginal discharge requiring showering or bathing two or three times daily. She states that despite bathing frequently, she never feels clean. She has had no other medical problems. Results of her last Pap smear 1 year ago were normal. She is not sexually active at this time and is taking no medications. She has never been pregnant. She works as a respiratory therapist at a local community hospital and recently broke up with a boyfriend of several months. Physical examination shows no abnormalities. Pelvic examination demonstrates no vaginal discharge, bleeding, or mucosal lesions. Uterus is normal-sized and nontender. Adnexa are palpable and there are no masses. In addition to obtaining cultures for gonorrhea and chlamydia, which of the following is the most appropriate next step?
A) Determine serum estrogen concentration
B) Order antibody studies for syphilis and HIV
C) Prescribe an oral anti-trichomonal medication and antifungal cream
[D) Question the patient regarding the circumstances surrounding her recent break-up]
E) Tell the patient you will wait for the Pap smear results before prescribing anything for the discharge
my answer is B
A) Determine serum estrogen concentration
B) Order antibody studies for syphilis and HIV
C) Prescribe an oral anti-trichomonal medication and antifungal cream
[D) Question the patient regarding the circumstances surrounding her recent break-up]
E) Tell the patient you will wait for the Pap smear results before prescribing anything for the discharge
my answer is B