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 #347674  
  ebnalfady - 10/12/08 04:41
 
  look at this qs
A 34-year-old Caucasian female presents to your office with perineal pruritus and vaginal discharge. Her past medical history is significant for acute sinusitis one week ago as well as allergic rhinitis. Pelvic examination shows erythematous vulva and thick. adherent, "cottage cheese-like" vaginal discharge. Microscopic examination of the vaginal discharge reveals budding cells. This patient's condition was most likely preceded by.
O A. Decreased thickness of the vaginal epithelium
O B. Increased glycogen concentration in the vaginal epithelium
O C. Decreased number of Gram-negative bacteria in the vagina
O D. Increased alkaline secretions by the cervical mucosa
O E. Depressed T-lymphocyte response to mucosal stimuli

then look at ur qs

http://www.usmleforum.com/files/forum/2008/1/347664.php

then look at the answer of my qs

Explanation:
Gram-negative lactobacilli comprise a major part of the normal vaginal flora. Other important colonizers include Corynebacteria. fungi (Candida). Streptococcus group B. and E. coil. These species exist in balance at the normal vaginal pH of 3.8 - 4.2. Changes in vaginal pH, damage to the vaginal microflora, and epithelial injury can all lead to increased growth of Candida and symptoms of vulvovaginitis. Candida vaginitis is the second most common cause of vaginitis.
Common triggers for Candida vaginitis include:
1 Antibiotic use suppresses normal bacterial flora, facilitating Candida overgrowth. This patient's history of acute sinusitis suggests recent antibiotic treatment.
2 Contraceptives, both oral and topical, alter vaginal pH.
3. Corticosteroid therapy
4. Uncontrolled diabetes mellitus.
5. Any other cause of immunosuppression, including HIV.
Patients with Candida vaginitis complain of vulvar pruritus and white, thick discharge. Physical examination reveals erythema of the vulvar and vaginal mucosa and "cottage-cheese"-like discharge. Vaginal pH is normal or slightly higher than normal (>4.5). Wet mount examination is diagnostic: it reveals budding yeast and pseudohyphae.
(Choices A and B) Decreased thickness of the vaginal epithelium and decreased amounts of glycogen in epithelial cells are characteristic of postmenopausal and lactating women. These changes are caused by low estrogen levels and lead to atrophic vaginitis. Yeast would not necessarily be isolated from the vaginal discharge of these patients.

Use of broad-spectrum antibiotics suppresses the normal bacterial flora of the vagina and facilitates Candida overgrowth. Antibiotic use is the most common cause of Candida vaginitis. Other potential causes include contraceptives, steroids, diabetes mellitus and immunosuppression
 
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* Re:to k.dr
#1506583
  ebnalfady - 10/12/08 04:49
 
  (Choices A and B) Decreased thickness of the vaginal epithelium and decreased amounts of glycogen in epithelial cells are characteristic of postmenopausal and lactating women  
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* Re:to k.dr
#1506591
  k.dr - 10/12/08 05:15
 
  yes the source of our q is the same. I just phrased it diff coz of copyright problems....
ok..i see what i missed...the candidiasis was due to possible antibiotic treatment of acute sinusitis...
While I was thinking along the lines of that an infection in the body (anywhere) can cause changes in body's normal flora and also changes in the vaginal pH....dont remember where I read that but I did.
Thank you ebnafaldy
 
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* Re:to k.dr
#3356303
  mohammedyousifrer - 12/30/17 03:43
 
  guys : lactobacili are gram positive not gram negative  
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