TDM Examination sample case G
Get familiar with the multiple-choice and short-menu question types you will see on the TDM Examination.
A 22-year-old woman presents to your clinic with a 4-day history of increased vaginal discharge and bothersome odour after intercourse. She is sexually active with a new female partner. She does not report pelvic pain, pruritus, dysuria, or abnormal bleeding. Her last menstrual period was 1 week ago. On examination, her vital signs are within normal limits. Speculum examination shows thin, homogenous, grey-white vaginal discharge without cervical motion tenderness.
Which of the following are the most appropriate medication options? Select 2.
The patient prefers an oral medication. Which of the following potential common adverse effects should be discussed with the patient? Select 2.
Which of the following recommendations should be provided to the patient at this visit? Select 2.
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Metronidazole is the first-line option for presumed bacterial vaginosis. Either oral or intravaginal metronidazole is recommended. Clotrimazole, fluconazole, miconazole, and nystatin are treatments for candidiasis. Nitrofurantoin and ciprofloxacin are urinary tract infection therapies. Ceftriaxone and azithromycin are used for specific sexually transmitted infections (e.g., gonorrhea, chlamydia). Metronidazole is the only option that covers anaerobic bacteria.
Sobel JD. Bacterial vaginosis: Initial treatment. UpToDate. Updated November 17, 2025. Accessed January 21, 2026.
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A metallic taste in the mouth and nausea are common adverse effects of oral metronidazole. Rash and prolonged QT are uncommon adverse reactions, while the remaining adverse effects—dry mouth, fatigue, hepatitis, jaundice, pruritus, and pseudomembranous colitis—are not reported to be associated with metronidazole use.
Abel S, Afolabi T, Al-Jazairi A, et al.; UpToDate Lexidrug Editorial Advisory Panel. Metronidazole (systemic): Drug information. UpToDate. Version 854.0. Accessed June 23, 2026.
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Vaginal douching should be avoided as it is associated with vaginal flora disruption and bacterial vaginosis recurrence. Given that the patient has a new sexual partner, sexually transmitted infection screening should be offered. Treatment of a female sexual partner is not routinely recommended. Repeat testing to ensure cure is not required if symptoms have resolved. Abstaining from sexual activity for 2 weeks is not required. Cervical cancer testing is not routinely offered in women under the age of 25 years
Sobel JD. Bacterial vaginosis: Initial treatment. UpToDate. Updated November 17, 2025. Accessed January 21, 2026.