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REPRO EXAM 2 > Beaton benign malignant vulva > Flashcards

Beaton benign malignant vulva Flashcards

1
Q

2 most common cause of PREpubertal vaginitis

A

Foreign body

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2
Q

How is the discharge of monilial vaginitis different from bacterial vaginosis?

A

candida is a thick white cottage cheese like discharge whereas bacterial vaginosis is homogenous, thin and whitish grey? and it smells like fish

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2
Q

How should the treatment regimen of bacterial vaginosis be adjusted in pregnancy?

A

They should be treated for a longer period of time

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3
Q

Tx for vulvar SCC?

A

radical vulvectomy; modified 3 incision approach has lower morbidity

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4
Q

Which type of organism most commonly overgrows in the vagina?

A

Bacterial vaginosis > monilial (yeast) vaginitis

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4
Q

List 6 predisposing factors to monilial vaginitis

A

Broad spectrum antibiotics, Corticosteroids, Oral contraceptives, Diabetes, Pregnancy and Tight fitting synthetic clothing

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4
Q

How is the etiology of prepubertal vaginitis different from post-menopausal vaginitis?

A

Prepubertal is usually an allergic rxn to bubble bath or foreign body; post-menopausal is an ATROPHIC vaginitis that is an age related change from ESTROGEN DEFICIENCY

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6
Q

What are the obstetric risks involved in bacterial vaginosis?

A

PROM, premature delivery, chorioamnionitis, and a 6x risk of post-cesarean endometritis in mothers who need c-section

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8
Q

When are you most likely to smell bacterial vaginosis in a patient and why? How does one of the diagnostic tests work on the same principle?

A

Usually smells the most around sex or menses due to a change in pH (relative alkalinzation). The KOH sniff/whiff test works on the same principle since hydroxide = base

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9
Q

3 pathological events that can happen to Bartholin’s glands

A

cysts, inflammation (bartholinitis), and abscess

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10
Q

Tx for Herpes genitalis

A

Valacyclovir or acyclovir; these activate thymidine kinase and become phosphorylated but lack 3’ OH so lead to chain termination of viral DNA replication

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11
Q

What is the second most common cause of floral overgrowth in the vagina?

A

Candidiasis aka monilial vaginitis

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11
Q

Which is more likely to cause a burning sensation on urination, bacterial vaginosis or monilial vaginitis?

A

monilial vaginitis, the vulvar surfaces become inflammed by overgrowth of yeast

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12
Q

1 most common cause of PREpubertal vaginitis

A

Allergic reaction to bubble baths

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12
Q

6 Tx for condylomata acuminata

A

Laser vaporization, Cryotherapy, topical 5-Fluorouracil, trichloroacetic acid, bichloroacetic acid, and 25% podophyllin

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13
Q

What is the most common cause of acute salpingitis?

A

Chlamydia trachomatis

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14
Q

What do you do if a woman is in labor and you notice that she has vesicular lesions on her vulva?

A

C section delivery; knowing them, the answer will be “low transverse” rather than vertical because it is so exquisitely board relevant

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15
Q

What does vulvar dystrophy usually look like, Tx?

A

thickened keratin response d/t acute insult; medium strenght corticosteroid

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16
Q

What is unique about fluconazole in the Tx of monilial vaginitis when compared to other azole options?

A

It is the simplest as it is an oral tablet vs. a cream, however it is only useful against 1 out of 3 of the causal Candida species

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16
Q

How is herpes genitalis usually contracted?

A

From a person with REACTIVATION of herpes as the first time is usually too painful that they usually wouldn?t want to have sex

16
Q

How can you clinically differentiate between vulvar dystrophy, vulvar intraepithelial neoplasia, and vulvar SCC?

A

You can’t, you need a biopsy

18
Q

How is the diagnosis of Trichomonas different from that of bacterial vaginosis and monilial vaginitis?

A

Trichomonas will show flagellated trichomonads on the smear, vaginosis will show clue cells and monilial vaginitis will show fungal hyphae after 10% KOH

18
Q

Next best step if cultures for PREpubertal vaginitis return as positive for chlamydia, mycoplasma, or gonorrhea

A

Consider sexual abuse

19
Q

How are the treatments for bacterial vaginosis and trichomonas vaginalis similar and different?

A

Both involve Tx with metronidazole. However, trichomonas only requires an oral treatment, not vaginal. Also, trichomonas requires TREATING THE PARTNER whereas this is usually not indicated in bacterial vaginosis unless recurrent

20
Q

T/F: bacterial vaginosis is an infective process

A

false it is due to normal flora imbalance and results in overgrowth

20
Q

Which disease is a sequela to an STD that results in peri-hepatitis with adhesions of Glisson’s capsule to the parietal peritoneum?

A

Fitz-Hugh-Curtis syndrome, this results from essentially a lymph node “metastasis” of Chlamydia trachomatis from the uterus to the perihepatic lymph nodes

21
Q

Buzzword: banjo string adhesions

A

Fitz-Hugh-Curtis syndrome, Chlamydia trachomatis

23
Q

T/F: Chlamydia will only increases the risk of post-partum endometritis

A

False, infection with Chlamydia increases the risks of both post-partum and post-cesarean endometritis

24
Q

How do you treat pathology of Bartholin’s gland?

A

you can incise and drain it, “Marsupialization” (get a kangaroo to punch it? Idk), gland excision, and if an infection is present give antibiotics

26
Q

Compare the use of 10% KOH in the diagnosis of bacterial vaginosis to that in monilial vaginitis

A

In bacterial vaginosis, KOH (10%) is part of the sniff test as the alkalinity produces a fishy smell. In the Dx of monilial vaginitis, 10% KOH is used in a wet mount because it kills off other organisms and leaves behind only the fungal hyphae

27
Q

How do you treat Vulvar dystrophy, lichen sclerosis type?

A

Potent steroid clobetasol

29
Q

Why is it likely that treating bacterial vaginosis can lead to monilial vaginitis and vice versa?

A

Because the bacteria and fungi are normal flora and both infections represent an imbalance of one with respect to the other, thus fixing one problem may push the balance to far to the other side.

30
Q

4 ways to Dx bacterial vaginosis

A

1) White/grey thin homogenous discharge that smells like feesh 2) Vaginal pH greater than 5 3) presence of clue cells on WET MOUNT 4) Positive sniff/whiff test with 10% KOH

31
Q

What should ya do if you see condylomata acuminata on the vulva?

A

Pap smear and culposcopy of the vulva, vagina, and cervix

33
Q

How are the Sx of Trichomonas vaginalis different from those of bacterial vaginosis?

A

Trichomonas will result in a yellow grey and frothy discharge whereas bacterial vaginosis is whitish grey and homogenous

34
Q

What is the most common Sx of vulvar neoplasia?

A

persistent itch

36
Q

T/F: bacterial vaginosis is very itchy

A

false it usually does not present with pruritis since there is no significant inflammatory process

36
Q

Prophylaxis for transmission of Chlamydia to the newborn

A

Erythromycin ointment

38
Q

A strawberry cervix is essentially pathognomonic for this

A

Trichomonas vaginalis

39
Q

What are the oral and vaginal treatments for bacterial vaginosis? When is treatment of the partner indicated?

A

Oral treatment is metronidazole (flagyl), vaginal treatment is contemporaneous with oral and is either metronidazole or clindamycin?. Partner should be treated when there are recurrent cases

40
Q

What should you do with any vulvar problem that doesn?t go away with treatment?

A

BIOPSY

41
Q

What are the 3 treatment strategies for treating herpes?

A

Episodic = treat when it happens; Prophylactic = short term daily low dose in anticipated times of stress; Suppressive = long term daily low dose

42
Q

This bug is implicated in some cases of vulvar intraepithelial neoplasia

A

HPV

43
Q

What is coaptation?

A

This is when the inflammatory response to herpes infection is so severe that the labia on the right and left fuse together when they heal

44
Q

What are the gynecologic risks of bacterial vaginosis?

A

Vaginal cuff cellulitis in post-hysterectomy patients

45
Q

What is the treatment of Chlamydia trachomatis?

A

Azithromycin (bind to P site of 50S)–SINGLE DOSE

47
Q

What does (extramammary) Paget’s disease of the vulva resemble?

A

severe candidiasis

48
Q

How should the treatment regimen of diabetic vulvitis be adjusted (still a fungal infection)?

A

You need to give antifungals to kill of the fungus but if blood sugars are not corrected, the problem will not abate

REPRO EXAM 2 (5 decks)

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