Gram-negative extracellular diplococci in cervical smear? - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 2 CK Forum

USMLE Step 2 CK Forum USMLE Step 2 CK Discussion Forum: Let's talk about anything related to USMLE Step 2 CK exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 04-22-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
ObGyn Gram-negative extracellular diplococci in cervical smear?

A 21-year-old female presents to her primary care provider with a 1-week history of vaginal pruritus. During this period, she has noticed an increase in vaginal discharge and describes it as having a yellow-green color to it. She is current sexually active with one partner and uses a combination oral contraceptive pill (OCP). She has had three previous sexual partners and denies any previous sexually transmitted diseases (STDs). Her previous medical history is unremarkable, and she denies any other symptoms. Physical examination reveals a mucopurulent cervical discharge that appears yellow-green when compared against a sheet of white paper. A Gram stain of vaginal material demonstrates Gram-negative extracellular diplococci. What is the most appropriate next step in management of this patient?

A. Culture on Thayer-Martin medium
B. Empirical ceftriaxone and doxycycline therapy for her alone
C. Empirical ceftriaxone and doxycycline therapy for her and her sexual partner
D. Empirical ceftriaxone therapy for her alone
E. Empirical ceftriaxone therapy for her and her sexual partner
F. Venereal Disease Research Laboratory (VDRL) titers

btw, what is the mcc of urethritis chlamydia or GC ?
Reply With Quote Quick reply to this message



  #2  
Old 04-22-2012
USMLE Forums Scout
 
Steps History: Not yet
Posts: 13
Threads: 3
Thanked 3 Times in 2 Posts
Reputation: 13
Default

E. Empirical ceftriaxone therapy for her and her sexual partner
Reply With Quote Quick reply to this message
The above post was thanked by:
tyagee (04-22-2012)
  #3  
Old 04-22-2012
XpaezX's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,216
Threads: 41
Thanked 1,327 Times in 711 Posts
Reputation: 1342
Default

Empirical ceftriaxone + doxycycline (azithromycin is better) , chlamydia cant be visualized on gram stain, and you always assume the patient has both bugs, chlamydia is more common than gonococcus in the US

Oh and you treat both patients as well
Reply With Quote Quick reply to this message
The above post was thanked by:
doc_study (04-22-2012), Mondoshawan (04-22-2012), tyagee (04-22-2012)
 
  #4  
Old 04-22-2012
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 76
Threads: 10
Thanked 31 Times in 27 Posts
Reputation: 41
Default .

answer. c .
Reply With Quote Quick reply to this message
The above post was thanked by:
tyagee (04-22-2012)
  #5  
Old 04-22-2012
USMLE Forums Scout
 
Steps History: Not yet
Posts: 61
Threads: 7
Thanked 82 Times in 32 Posts
Reputation: 92
Default

Chlamydia is the mcc of STD in USA. However it is clinically silent most of the times. Gonorrhea is also very common and presents with discharge. ALL PATIENTS SUSPECTED WITH STD SHOULD BE TREATED WITH CEFTRIAXONE+AZITHROMYCIN/DOXYCYCLINE (always suspect chlamydia co-infection in a pt with gonorrhea)! And treat partner as well...

Thats what I feel...
Reply With Quote Quick reply to this message
The above post was thanked by:
tyagee (04-22-2012)
  #6  
Old 04-22-2012
tyagee's Avatar
USMLE Forums Master
 
Steps History: ---
Posts: 1,365
Threads: 648
Thanked 591 Times in 355 Posts
Reputation: 601
Default qbank says corect ans is A.wohohoho...

this is what the online qbank[not usmleworld] says [ from where i picked the q]
i think its wrong ans. in the qbank .... it does nt make sense to me at least...anyone?

Explanation
Option A (Culture on Thayer-Martin medium) is correct. This patient may have gonorrhea, but demonstrating extracellular gram-negative diplococci can be a part of the normal vaginal flora. Neisseria gonorrhea exists intracellularly. It is important to note that for cases of sexual abuse or assault, the only legally defensible demonstration of gonorrhea is culture.

Option B (Empirical ceftriaxone and doxycycline therapy for her alone) is incorrect. This is the correct pharmacotherapy for her, but her partner should be treated as well.

Option C (Empirical ceftriaxone and doxycycline therapy for her and her sexual partner) is incorrect. Once there is a diagnosis, this is the most appropriate next step in the management of this patient. Of course, an examination and investigation of her partner is desired, but in some circumstances treatment is possible without physician contact.

Option D (Empirical ceftriaxone therapy for her alone) is incorrect. This is the correct drug for Neisseria gonorrhea, but not the correct regimen for two reasons. First, once gonorrhea is diagnosed, chlamydia should be empirically treated, because both conditions frequently coexist, and it is much more difficult to detect chlamydia. Second, her partner should be treated or else she risks reinfection.

Option E (Empirical ceftriaxone therapy for her and her sexual partner) is incorrect. Her partner does require treatment, a principle called “epidemiologic treatment,” but a diagnosis has not been made yet.

Option F (Venereal Disease Research Laboratory [VDRL] titers) is incorrect. Venereal Disease Research Laboratory (VDRL) is a nonspecific test for investigation of syphilis. This patient does not have the painless ulcer (chancre) associated with syphilis, nor does she have any other signs or symptoms consistent with syphilis.
Reply With Quote Quick reply to this message
The above post was thanked by:
eriqaly (07-20-2015)
  #7  
Old 04-22-2012
XpaezX's Avatar
USMLE Forums Master
 
Steps History: 1+CK+CS+3
Posts: 1,216
Threads: 41
Thanked 1,327 Times in 711 Posts
Reputation: 1342
Thumbs Down

well if not uworld then that qbank is extremely wrong, even harrison's says that you should treat, she has all the signs and symptoms of STD due to both gonorrhea and Chlamydia, waiting for culture would delay treatment and spread of the disease, we dont know who cheated on who nor does it matter, they must be treated according to epidemiology basis (and I find ironic that they base one of the answer according to epidemiology but then admit you have to wait for culture.. where as empirical treatment then gone?) and history and physical... I would still pick Ceftriaxone and Doxy/azithromycin on both her and her partner

So I agree with you here tyagee, i dont find their logic correct...

Last edited by XpaezX; 04-22-2012 at 01:40 PM.
Reply With Quote Quick reply to this message
The above post was thanked by:
tyagee (04-24-2012)
  #8  
Old 01-12-2013
USMLE Forums Master
 
Steps History: 1+CK+CS
Posts: 1,867
Threads: 149
Thanked 2,107 Times in 1,049 Posts
Reputation: 2127
Default

The Q Bank answer is correct according to CDC


Quote:
Laboratory criteria for diagnosis
• Isolation of typical gram-negative, oxidase-positive diplococci (presumptive Neisseria gonorrhoeae) from a
clinical specimen, or
• Demonstration of N. gonorrhoeae in a clinical specimen by detection of antigen or nucleic acid, or
• Observation of gram-negative intracellular diplococci in a urethral smear obtained from a male
Case classification
Probable: a) demonstration of gram-negative intracellular diplococci in an endocervical smear obtained from a
female or b) a written morbidity report of gonorrhea submitted by a physician
Confirmed: a case that is laboratory confirmed

Quote:
A Presumptive diagnosis of gonorrhea is made on the basis of one of the following three criteria:
  1. typical gram-negative intracellular diplococci on microscopic examination of a smear of urethral exudate from men or endocervical secretions from women*;
  2. growth of a gram-negative, oxidase-positive diplococcus, from the urethra (men) or endocervix (women), on a selective culture medium, and demonstration of typical colonial morphology, positive oxidase reaction, and typical gram- negative morphology;
  3. detection of N. gonorrhoeae by a nonculture laboratory test (Antigen detection test (e.g., Gonozyme [Abbott]), direct specimen nucleic acid probe test (e.g., Pace II [GenProbe]), nucleic acid amplification test (e.g., LCR [Abbott]).
* The observation of gram-negative, intracellular diplococci on microscopic examination of endocervical secretions from women must be supported by a positive result from a test from either 2 or 3 to make a laboratory diagnosis of “presumptive N. gonorrhoeae.”
Quote:
Normal female flora include: gram-positive
cocci, gram-positive bacilli, and gram-negative
bacilli; Neisseria organisms would be expected
in a sexually active or sexually abused patient;
gram-negative diplococci are diagnostically
significant for gonococcal infection only in a
urethral smear from a man; women may have
saprophytic gram-negative diplococci in the
genital tract;
__________________
A man doesn't know what he knows until he knows what he doesn't know.
“What is man? He's just a collection of chemicals with delusions of grandeur.”

Last edited by Novobiocin; 01-12-2013 at 10:38 AM.
Reply With Quote Quick reply to this message



Reply

Tags
Infectious-Diseases, ObGyn-, Step-2-Questions

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
Pap Smear Recommendation and Cervical Cancer Screening Kais_MD USMLE Step 2 CK Forum 14 11-16-2011 06:37 PM
Short gram negative rods in the CSF! menatallah Elgohary USMLE Step 1 Forum 6 09-19-2011 04:51 PM
Pleomorphic gram-negative bacilli grown from the eye discharge ricko335 USMLE Step 1 Forum 7 09-18-2011 03:19 AM
Oxidase-negative, Motile, Gram-negative Bacillus! rulz USMLE Step 1 Forum 8 07-31-2011 08:09 AM
Gram Negative non-fermenters rods in Urine! INCOGNITO USMLE Step 1 Forum 7 07-09-2011 11:01 AM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)