Exam MCCQE Topic 1 Question 192 Discussion
Actual exam question for Medical Council of Canada's MCCQE exam
Question #: 192
Topic #: 1
Question #: 192
Topic #: 1
A 28-year-old nulligravid woman presents to your clinic with grey-green vaginal discharge that has a "fishy- type odour." Microscopy reveals superficial squamous cells with blurred borders caused by adherent bacteria.
The patient's symptoms abate after therapy with vaginal metronidazole. Which one of the following is the most likely cause of this clinical presentation?
The patient's symptoms abate after therapy with vaginal metronidazole. Which one of the following is the most likely cause of this clinical presentation?
Suggested Answer: B Vote an answer
This presentation is classic for bacterial vaginosis (BV) . MCCQE objectives emphasize recognition of BV by its typical features: thin grey/grey-green discharge , fishy (amine) odour , and microscopy showing clue cells
-vaginal epithelial (superficial squamous) cells with blurred borders from adherent bacteria. BV results from a shift in vaginal flora away from lactobacilli toward anaerobes, with Gardnerella vaginalis commonly implicated and often present in polymicrobial overgrowth. Improvement with metronidazole further supports BV, as it is first-line therapy.
Other options do not match: HPV causes genital warts/cervical dysplasia, not malodorous discharge with clue cells. Trichomonas typically causes frothy yellow-green discharge, "strawberry cervix," and motile trichomonads on wet mount (not clue cells). Chlamydia and gonorrhea cause cervicitis/PID with mucopurulent discharge and pelvic symptoms rather than fishy odour and clue cells. Therefore, Gardnerella vaginalis is the most likely cause.
-vaginal epithelial (superficial squamous) cells with blurred borders from adherent bacteria. BV results from a shift in vaginal flora away from lactobacilli toward anaerobes, with Gardnerella vaginalis commonly implicated and often present in polymicrobial overgrowth. Improvement with metronidazole further supports BV, as it is first-line therapy.
Other options do not match: HPV causes genital warts/cervical dysplasia, not malodorous discharge with clue cells. Trichomonas typically causes frothy yellow-green discharge, "strawberry cervix," and motile trichomonads on wet mount (not clue cells). Chlamydia and gonorrhea cause cervicitis/PID with mucopurulent discharge and pelvic symptoms rather than fishy odour and clue cells. Therefore, Gardnerella vaginalis is the most likely cause.
by Yvette at Aug 15, 2026, 04:05 AM
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