This case wasn't included in any USMLE step 2 CS review book when I took my exam in summer of 2008, ( I am not sure about that now), you have to proceed to that case as follows.
Scenario: A lady presents for followup of her gynecologic problem, vaginal sample taken at that time turns out to be positive for Trichomonas Vaginalis
The patient appears in her formal clothing and not in the gown. Counseling is the most important part of this case. Here is how to approach this case.
Good Morning Miss Jane, this is Dr MD. Nice to see you.
(Good Morning Doc)
I am here to discuss with you the lab results of the vaginal sample taken from you a few days back.
(OK Doc)
The results show that you have been infected with a bug called Trichomonas Vaginalis and the condition is called Trichomoniasis.
(Is it serious doc?)
It is a sexually transmitted disease but it’s not a serious condition. The bug which causes it mainly resides in the female genital tract. It can be asymptomatic or may cause itching, burning and pain with intercourse. It can also causes frothy green vaginal discharge. But there are also some other conditions that can cause similar problems. To rule out any other coexisting conditions let me ask you some questions first.
(Sure Doc)
Do you have any fever?
(No)
Do you have any vaginal discharge?
(No)
If yes, then ask about itching, foul smell etc
Are you sexually active?
(Yes)
Who’s you partner?
(My Boy friend)
Any other partner?
(No doc)
Do you use any method of contraception?
(Some times we use condoms doc)
When was your LMP?
(Three weeks ago)
Are your cycles regular?
(Yes doc, they are mostly regular)
Is there a chance for you to be pregnant?
(I am not sure doc)
Have you ever had any sexually transmitted disease? Any rash? Genital lesions or lymph gland enlargement?
(No doc)
Do you have any new complaints?
(No doc)
Ok Miss _____ I would like to repeat the physical exam on you today. (You just have to mention this and there is no need to actually do it)
Do you have any questions or concerns?
(No Doc)
Ok Ms____ I am going to prescribe you a drug called Metronidazole. It is a very safe and effective treatment for this condition but I would like you to be aware of few side effects such as stomach upsets & metallic taste in the mouth.
You should also avoid getting pregnant while you are on this drug. I would recommend you to either avoid sexual intercourse or use a strong method of contraception.
Have you had a recent pregnancy test? If not I would advise you to take one. I would also like you to bring your partner to me so that he can be examined and treated as well, so that your risk of getting re-infected is minimized.
I would also like you to know how to avoid Trichomoniasis in the future. Get you and your partner treated
Use barrier methods of contraception.
Do you have any questions?
( no doc)
Ok Ms___ thanks for your cooperation, it was nice working with you. Have a good day.
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