{"id":4148,"date":"2024-08-14T17:41:00","date_gmt":"2024-08-14T17:41:00","guid":{"rendered":"https:\/\/www.osmosis.org\/blog\/?p=4148"},"modified":"2025-10-02T13:52:04","modified_gmt":"2025-10-02T21:52:04","slug":"pance-question-of-the-day-candida","status":"publish","type":"post","link":"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-candida","title":{"rendered":"PANCE\u00ae Question of the Day: Candida"},"content":{"rendered":"<div id=\"ez-toc-container\" class=\"ez-toc-v2_0_80 ez-toc-wrap-center counter-hierarchy ez-toc-counter ez-toc-custom ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">In This Article<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-candida\/#The_correct_answer_to_todays_PANCE%C2%AE_Question_is%E2%80%A6\" >The correct answer to today&#8217;s PANCE\u00ae Question is&#8230;<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-candida\/#Incorrect_Answer_Explanations\" >Incorrect Answer Explanations<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-candida\/#Main_Explanation\" >Main Explanation<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-candida\/#Major_Takeaway\" >Major Takeaway<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-candida\/#References\" >References<\/a><\/li><\/ul><\/nav><\/div>\n\n<p class=\"wp-block-paragraph\"><strong>Prepare for the PANCE: A 32-year-old woman with frequent urination, thirst, yeast infections, and insulin resistance signs\u2014what lab confirms the diagnosis?<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 32-year-old woman presents to the office for evaluation of frequent urination and increased thirst for 6 months without associated dysuria or hematuria. She has had vaginal itching with increased thick, white vaginal discharge without odor. She has used over-the-counter treatments two times in the past three months to treat possible yeast infections, but the discharge and itching return. She has no known medical history and does not have a primary care provider. Family history is significant for diabetes mellitus in her mother and older sister, as well as hypothyroidism in her sister. Temperature is 36.9\u00b0C (98.5\u00b0F), pulse is 82\/minute, blood pressure is 140\/82 mmHg, BMI is 30. Skin examination reveals multiple skin tags on her neck and axilla and darkened, velvety skin on her neck. Cardiac and pulmonary examinations are unremarkable. On genitourinary examination, she has vulvar erythema and edema with white, thick discharge. Wet mount of the vaginal discharge confirms the presence of candida. Which of the following laboratory studies is most likely to confirm this patient\u2019s primary diagnosis?&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A.&nbsp;Hemoglobin A1C&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B.&nbsp;Urinalysis&nbsp;C.&nbsp;Complete Blood Count&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D.&nbsp;Complete Metabolic Panel&nbsp;<\/strong><strong>E.&nbsp;Thyroid panel&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Scroll down to find the answer!<em>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;<\/em><\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"The_correct_answer_to_todays_PANCE%C2%AE_Question_is%E2%80%A6\"><\/span>The correct answer to today&#8217;s PANCE\u00ae Question is&#8230;<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>A.&nbsp;Hemoglobin A1C&nbsp;<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Before we get to the Main Explanation, let&#8217;s look at the incorrect answer explanations. Skip to the bottom if you want to see the correct answer right away!<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Incorrect_Answer_Explanations\"><\/span>Incorrect Answer Explanations<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">The incorrect answers to today&#8217;s PANCE\u00ae Question are&#8230;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>B.\u00a0Urinalysis\u00a0<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;The patient is presenting with complaints of frequent urination and also has vaginal discharge and itching. While a urinalysis is reasonable to evaluate for urinary tract infection, the most likely underlying diagnosis is type 2 diabetes mellitus which would be confirmed with a hemoglobin A1C.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>C.\u00a0Complete Blood Count<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;This patient presents with frequent urination without dysuria, increased thirst, and recurrent vaginal yeast infections. Type 2 diabetes mellitus is the most likely underlying condition which can be diagnosed with a hemoglobin A1C.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>D.\u00a0Complete Metabolic Panel\u00a0<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:&nbsp;<\/strong>Complete metabolic panel should be done as part of the workup in patients diagnosed with diabetes. Assessing renal function and having a baseline is important, but it would not diagnose diabetes mellitus.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>E.\u00a0Thyroid panel\u00a0<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Incorrect:<\/strong>&nbsp;This patient presents with a history of yeast infections, polyuria, polydipsia, and a family history of diabetes mellitus suggesting a diagnosis of diabetes mellitus type 2. This would not be diagnosed with a thyroid panel.&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Main_Explanation\"><\/span>Main Explanation<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">This patient presents with&nbsp;classic symptoms of diabetes mellitus (polyuria and polydipsia) and recurrent yeast infections.&nbsp;Hyperglycemia increases the risk for bacterial and fungal infections which explains her recurrent yeast infections. Combined with her physical examination findings and family history, diabetes mellitus type 2 is the most likely diagnosis.<\/p>\n\n\n\n<figure class=\"wp-block-image size-large\"><img loading=\"lazy\" decoding=\"async\" height=\"484\" width=\"1024\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/lab-findings.png?w=1024\" alt=\"LABS\nHemoglobin A1C &gt;= 6.5%\nFasting Blood Glucose = 126 mg\/dL\nRandom Blood Glucose &gt;= 200 mg\/dL\n2-Hour OGTT &gt;= 200 mg\/dL\nDIABETES MELLITUS\nLABS\n* Glutamic Acid Decarboxylase (GAD65) Antibodies\n* Islet Cell (ICA2) Antibodies\n* C-Peptide levels\" class=\"wp-image-4150\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/lab-findings.png 1244w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/lab-findings.png?resize=300,142 300w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/lab-findings.png?resize=768,363 768w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/09\/lab-findings.png?resize=1024,484 1024w\" sizes=\"auto, (max-width: 1024px) 100vw, 1024px\" \/><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\">The diagnosis of diabetes mellitus can be made using the&nbsp;glycated hemoglobin A1C (HbA1C) or plasma glucose concentration (fasting, random, or 2 hour glucose tolerance test). HbA1C is the most widely used test to estimate mean glucose using glycated hemoglobin. The level of glycated hemoglobin shows the&nbsp;mean plasma glucose level during the previous&nbsp;1-3 months.&nbsp;HbA1C values&nbsp;5.7-6.4%&nbsp;are consistent with a diagnosis of&nbsp;pre-diabetes, while values&nbsp;\u2265&nbsp;6.5%&nbsp;confirm a diagnosis of&nbsp;diabetes mellitus. Prediabetes is a precursor to diabetes in which patients may be asymptomatic with elevated blood sugars. It is important to identify and intervene to prevent progression to diabetes mellitus.&nbsp;&nbsp;&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Fasting plasma glucose&nbsp;is obtained from a blood sample after the patient has fasted for 8 hours. Values&nbsp;100-125 mg\/dL&nbsp;are consistent with a diagnosis of&nbsp;pre-diabetes, while a level&nbsp;\u2265 126 mg\/dL&nbsp;is consistent with&nbsp;diabetes mellitus.&nbsp;&nbsp;A glucose tolerance test measures plasma glucose levels both before and 2 hours after a patient has ingested 75 grams of glucose. Pre-diabetes is diagnosed with levels 140-199 mg\/dL. While diabetes mellitus is diagnosed when levels are \u2265 200 mg\/dL. Lastly, a random blood glucose \u2265 200 mg\/dL in patients presenting with classic symptoms of diabetes mellitus (polyuria, polydipsia, polyphagia and weight loss) is diagnostic of diabetes mellitus.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Obtaining levels for glutamic acid decarboxylase (GAD65 antibodies), islet cell (ICA2 antibodies), and C-peptide helps to differentiate between type 1 and type 2 diabetes mellitus. Positive GAD65 or ICA2 antibodies with low C-peptide levels&nbsp;confirms a diagnosis of&nbsp;type 1 diabetes mellitus.&nbsp;&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"Major_Takeaway\"><\/span>Major Takeaway<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<p class=\"wp-block-paragraph\">Patients presenting with classic symptoms of diabetes mellitus or risk factors for diabetes mellitus should be evaluated with bloodwork. Diagnosis can be made using hemoglobin A1C or the plasma glucose concentration (fasting, 2 hour glucose tolerance test, or random glucose).&nbsp;&nbsp;<\/p>\n\n\n\n<h2 class=\"wp-block-heading\"><span class=\"ez-toc-section\" id=\"References\"><\/span>References<span class=\"ez-toc-section-end\"><\/span><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>American Diabetes Association;&nbsp;Standards of Care in Diabetes\u20142023&nbsp;Abridged for Primary Care Providers.&nbsp;Clin Diabetes&nbsp;2 January 2023; 41 (1): 4\u201331.&nbsp;<a href=\"https:\/\/doi.org\/10.2337\/cd23-as01\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/doi.org\/10.2337\/cd23-as01<\/a>&nbsp;<\/li>\n\n\n\n<li>Vijan, S. (2019). Type 2 diabetes.&nbsp;Annals of Internal Medicine,&nbsp;171(9).&nbsp;<a href=\"https:\/\/doi.org\/10.7326\/aitc201911050\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/doi.org\/10.7326\/aitc201911050<\/a>&nbsp;&nbsp;<\/li>\n<\/ul>\n\n\n\n<figure class=\"wp-block-image size-large\"><a href=\"https:\/\/www.osmosis.org\/plans\/md\" target=\"_blank\" rel=\"noreferrer noopener\"><img loading=\"lazy\" decoding=\"async\" width=\"700\" height=\"250\" src=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/health-medicine-try-it-now.png?w=700\" alt=\"The most powerful platform for learning medicine and the health sciences Try it now button.\" class=\"wp-image-363\" srcset=\"https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/health-medicine-try-it-now.png 700w, https:\/\/www.osmosis.org\/blog\/wp-content\/uploads\/sites\/2\/2024\/08\/health-medicine-try-it-now.png?resize=300,107 300w\" sizes=\"auto, (max-width: 700px) 100vw, 700px\" \/><\/a><\/figure>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><em>Want more PANCE\u00ae-style practice questions? Try Osmosis by Elsevier today! Access your&nbsp;<a href=\"https:\/\/www.osmosis.org\/login?type=create\" target=\"_blank\" rel=\"noreferrer noopener\">free trial<\/a>&nbsp;and discover why millions of current and future clinicians and caregivers love learning with us.<\/em><\/strong><a href=\"https:\/\/www.osmosis.org\/plans\/rn\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><a href=\"https:\/\/www.osmosis.org\/plans\/rn\" target=\"_blank\" rel=\"noreferrer noopener\"><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Prepare for the PANCE: A 32-year-old woman with frequent urination, thirst, yeast infections, and insulin resistance signs\u2014what lab confirms the diagnosis? A 32-year-old woman presents to the office for evaluation of frequent urination and increased thirst for 6 months without associated dysuria or hematuria. She has had vaginal itching with increased thick, white vaginal discharge [&hellip;]<\/p>\n","protected":false},"author":204,"featured_media":4149,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_jetpack_newsletter_access":"","_jetpack_dont_email_post_to_subs":false,"_jetpack_newsletter_tier_id":0,"_jetpack_memberships_contains_paywalled_content":false,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_post_was_ever_published":false},"categories":[20,38,1371,37],"tags":[],"class_list":["post-4148","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-exam-prep","category-pance","category-pance-questions","category-pa"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v23.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>PANCE\u00ae Question of the Day: Candida - Osmosis Blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.osmosis.org\/blog\/pance-question-of-the-day-candida\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"PANCE\u00ae Question of the Day: Candida - Osmosis Blog\" \/>\n<meta property=\"og:description\" content=\"Prepare for the PANCE: A 32-year-old woman with frequent urination, thirst, yeast infections, and insulin resistance signs\u2014what lab confirms the diagnosis? 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