Problem
E. B. is a 34 yr. old who presents to the clinic for evaluation of a foul-smelling vaginal discharge that has been present for a little over 1 week. She denies any vaginal itching, burning with urination, fever, chills, abdominal pain, or pelvic pain. Her last menstrual period was 10 days ago. Mrs. B. is sexually active in a monogamous relationship with her husband of 8 years. She had a bilateral tubal ligation after the birth of her last child, 3 years ago. Mrs. B.'s past medical history is unremarkable with no chronic health conditions reported.
i. What additional questions would you ask Mrs. B. and why? List a minimum of 6 questions and provide a rationale for each.
ii. When performing a pelvic examination on any female patient - not just Mrs. B., what pertinent positive and pertinent negative findings from the external, internal and bimanual parts of the exam should be documented? List findings for each part separately.
iii. Describe the procedure(s) for preparing samples of the discharge for review under the microscope and what findings each may provide.
iv. How might pH testing be useful in evaluating vaginal discharge?
v. Prior to microscopy verification, what would you include on your list of differential diagnoses (DD), and why?
vi. What would be the diagnosis for Mrs. B. and why?