Benign and Malignant Conditions of the Vagina and Vulva (Moulton)

Question 1

Clitoromegaly, Clitoral agenesis, Bifid clitoris, Midline fusion of the labiascrotal folds, and Cloaca are all presentations of?

They are congenital anomalies of the?

Answer 1

1) Ambiguous genitalia

2) Vulva

Question 2

Clitoral agenesis results secondary to failure of the ____ to form.

Answer 2

Genital tubercle

Question 3

No definite separation between the vagina & bladder results in?

Answer 3

Cloaca

Question 4

What is caused by masculinization in utero of the female fetus?

Answer 4

Female pseudohermaphroditism

Question 5

Congenital Adrenal hyperplasia, Ingestion of exogenous hormones, and Androgen secreting tumors of the mothers adrenal or ovaries all can lead to?

Answer 5

Female pseudohermaphroditism

Question 6

The most obvious abnormalities of female pseudohermaphroditism are __1__, __2__, and __3__.

Answer 6

1) Clitoromegaly
2) Hypospadiac urethra meatus
3) Malpositioned vaginal orifice

Question 7

____ insensitivity, which may be seen in ambiguous genitalia, is caused by a genetic deficiency in ____ receptors

Answer 7

Androgen

Question 8

1) What karyotype is seen in ambiguous genitalia with androgen insensitivity?

Ambiguous genitalia is most commonly an X-linked __2__ disorder.

Answer 8

1) 46 XY

2) Recessive

Question 9

With ambiguous genitalia , __1__ inhibiting substance is produced by the 46xy which results in lack of __1__ duct development.

2) This results in what structures to be absent?

Answer 9

1) Mullerian

2) Uterus or fallopian tubes

Question 10

What structural and benign neoplastic condition of the vulva is treated with estrogen cream and massage to separate the labia majora?

Answer 10

Labial agglutination

Question 11

1) What structural and benign neoplastic condition of the vulva causes severe pruritic raised yellow retention cyst in the axilla, labia majora and minora?

It results from __2__ plugged inflammation of __3__ glands.

Answer 11

1) Fox-Fordyce disease
2) Keratin
3) Apocrine

Question 12

__1__ are the most common type of genital cyst.

They develop when the __2__ become obstructed.

Answer 12

1) Epidermal inclusion cysts

2) Hair follicles

Question 13

What can enlarge and become painful in pregnancy and have characteristic blue color?

Answer 13

Vulvar varicosities

Question 14

__1__ appear as a small fleshy red outgrowth at the distal edge of the urethra.

In children they are caused by the spontaneous prolapse of the __2__.

In post menopausal women it is secondary to contraction of the hypoestrogenic __3__ epithelium resulting in everting of the __4__ epithelium.

Answer 14

1) Urethral caruncles
2) Urethral epithelium
3) Vaginal
4) Urethral

Question 15

__1__ is a rare condition in which one or more of the minor vestibular glands becomes infected resulting in 1 - 4mm erythematous dots that are extremely tender.

They are characterized by severe __2__ and occasionally vulvar pain.

It may be treated with topical __3__ and __3__ or surgical therapy may be required.

Answer 15

1) Vulvar vesitbulitis (Vestibular adenitis)
2) Dyspareunia
3) Estrogens/hydrocortisone

Question 16

What are small, smooth, nodular masses usually on inner surface of labia minora and majora due to inflammatory blockage of its ducts?

How can the material that they contain be described?

Answer 16

1) Sebaceous cyst

2) Cheesy sebaceous material

Question 17

What are the most common benign solid tumors of the vulva? They are slow growing, most range from 1-10 cm.

Answer 17

Fibromas

Question 18

What are slow growing tumors composed of adipose cells?

Answer 18

Lipoma

Question 19

What are rare lesions arising from sweat gland of the vulva?

Answer 19

Hidradenoma

Question 20

Syringoma is a(n) ____ gland tumor.

Answer 20

Eccrine

Question 21

What tumor can occur due to Von Recklinghausen’s disease?

Answer 21

Neurofibroma

Question 22

What tumor appear as multiple 2-3 mm red lesions usually in fourth & fifth decade?

Answer 22

Angioma

Question 23

What are loculated collections of blood that collect following trauma such as bike injuries (straddle injury), birth trauma or sexual assault?

Answer 23

Vulvar hematomas

Question 24

An exam that reveals atrophy of the external genitalia and loss of vaginal rugae is diagnostic of __1__.

It is due to loss of __2__, which may occur due to menopause or surgery.

Treatment involves __3__.

Answer 24

1) Atrophic vaginitis
2) Estrogen
3) Topical estrogen (may use oral to prevent recurrence)

Question 25

Local thickening of epithelium that reveals white, leathery, raised surface is diagnostic of? What does it results from?

Answer 25

1) Lichen simplex chronicus (Squamous cell hyperplasia) | 2) Chronic itching of the area

Question 26

What does biopsy of Lichen simplex chronicus reveal?

Answer 26

1) Elongated rete ridges | 2) Hyperkeratosis of keratin layer

Question 27

__1__ reveals thin, white, inelastic skin with a crinkled tissue paper appearance that causes pruritus, dyspareunia, and burning pain. It is frequently found on the vulva of __2__women.

Answer 27

1) Lichen sclerosis | 2) Menopausal

Question 28

4% of treated women & 10% of untreated women with lichen sclerosis can develop ____ of the vulva.

Answer 28

Squamous cells cancer

Question 29

What does biopsy of Lichen sclerosis reveal?

Answer 29

1) Thin epithelium 2) Loss of rete ridges 3) Inflammatory cells lining basement membrane

Question 30

Lichen simplex chronicus presents with marked hyperkeratosis and parakeratosis with a prominent ____ layer.

Answer 30

Granular

Question 31

The most striking feature of lichen sclerosis is the presence of a ____ zone in the superficial dermis. This is the result of edema and degeneration of the collagen and elastic fibers of the dermis.

Answer 31

Hyaline

Question 32

Purplish, polygonal papules that may appear in an erosive form causing vulvar burning and severe dyspareunia is diagnostic of?

Answer 32

Lichen planus

Question 33

Autoimmune blistering disease involving the vulvovaginal conjunctival areas is characteristic of?

Answer 33

Pemphigus

Question 34

What syndrome classically involves ulcerations in the genital, oral areas with uveitis?

Answer 34

Bechet's syndrome

Question 35

What is primarily a GI disorder but vulvar ulcerations can occur due to fistulations?

Answer 35

Chron's

Question 36

What ulcers can develop when chronic pressure is applied or secondary to tissue being moist secondary to urinary incontinence?

Answer 36

Decubitus ulcers

Question 37

1) After birth, what bulging membrane-like structure may be noticed in the vaginal opening which can block the egress of mucus? If it is not detected until after menarche, it can appear as a __2__ structure which entraps __3__.

Answer 37

1) Imperforate hymen 2) Thin dark bluish 3) Menstrual flow

Question 38

What type of vaginal septum is most commonly found in the upper and middle thirds of the vagina and often a small sinus tract or perforation will be present which allows the egress of menstrual flow?

Answer 38

Transverse vaginal septum

Question 39

What type of vaginal septum creates a double vagina and can attach to the lateral wall thus creating a blind vaginal pouch?

Answer 39

Midline longitudinal vaginal septum

Question 40

Which vaginal septum are usually associated with various duplication anomalies of the uterine fundus?

Answer 40

Midline longitudinal vaginal septum

Question 41

Vaginal agenesis is the most extreme vaginal anomaly with total absence of the vagina except for the most distal portion that is derived from?

Answer 41

Urogenital sinus

Question 42

Rokintansky-Kuster-Hauser Syndrome (Mullerian agenesis) presents if __1__ is absent but __2__ are spared.

Answer 42

1) Uterus | 2) Fallopian tubes

Question 43

____ of the vaginal wall consists of islands of columnar cells in normal squamous epithelium and are seen in women who have been exposed to DES in utero.

Answer 43

Adenosis

Question 44

____ arise from the remnant of the Wolffian duct (mesonephros). They vary in size from 1-5 cm and are found in the ____ of the vagina

Answer 44

1) Gartner's duct cyst | 2) Lateral walls

Question 45

What small 0.3 - 3.0 cm sac like projections in the anterior vagina along the posterior urethra that can cause recurrent UTI, dysuria, and occasionally urinary leaking?

Answer 45

Urethral diverticula

Question 46

What cysts are located in the posterior or lateral wall in the lower third of the vagina and are frequently associated with gynecologic surgery or lacerations from childbirth? They result from infolding of the?

Answer 46

1) Inclusion cyst | 2) Vaginal epithelium

Question 47

Endometriosis is caused by implants seen in the vagina and they change in appearance with the?

Answer 47

Menstrual cycle

Question 48

What asymptomatic cyst usually presents as an unilateral swelling and is the most common vulvovaginal tumor?

Answer 48

Bartholin's cyst

Question 49

What painful inflammatory mass arises from blockage and accumulation of purulent material?

Answer 49

Bartholin's gland abscess

Question 50

What is characterized by leaving in for 4-6 weeks which promotes an epithelialized tract for drainage of glandular secretions? What is characterized by creating a new ductal opening by everting the cyst wall onto the epithelial surface where it is sutured with interrupted absorbable sutures? Both of these treatments are used for?

Answer 50

1) Word catheterization 2) Marsupialization 3) Bartholin's gland abscess

Question 51

What structural change is characterized by anterior vaginal prolapse? What structural change is characterized by posterior vaginal prolapse?

Answer 51

1) Cystocele | 2) Rectocele

Question 52

Rectovaginal, urethrovaginal, and vesicovaginal ____ can result from radiation, obstetric injuries, complications of surgery.

Answer 52

Fistulas

Question 53

The most common cause of vaginal trauma is?

Answer 53

Sexual assault

Question 54

After menopause the vaginal __1__ flatten out and the vaginal __2__becomes thin, pale, & inelastic. 3) What happens to the vaginal pH?

Answer 54

1) Rugations 2) Epithelium 3) Rises

Question 55

The most common malignant tumors of the vulva are?

Answer 55

Squamous Cell Carcinomas

Question 56

Squamous Cell Carcinomas occur mainly in what population of women? The most frequently reported symptom of vulvar cancer is long history of?

Answer 56

1) Postmenopausal | 2) Chronic vulvar pruritis

Question 57

Vulvar intraepithelial (VIN) I-III are designated based upon the? Which is aka as squamous cell carcinoma in situ has been linked to vulvar cancer?

Answer 57

1) Depth of epithelial involvement | 2) VIN III

Question 58

VIN type III is subdivided into two groups, the VIN usual type is associated with? What preventative measure should cause a decrease the VIN usual type? The differentiated type VIN is more commonly associated with vulvar dermatologic conditions, such as?

Answer 58

1) HPV 16, smoking, and immunocompromised status 2) Gardasil vaccine 3) Lichen sclerosis

Question 59

What occurs in postmenopausal white females and is characterized as well demarcated and eczematoid in appearance with fiery red background with white plaque like lesions in the vulva that can also occur in the nipple areas of the breast?

Answer 59

Paget's disease

Question 60

What presents in post menopausal females between 70-80 y/o with a lesion that is pruritic, raised, ulcerated, pigmented or warty in appearance usually on labia majora?

Answer 60

Squamous cell vulvar carcinoma

Question 61

What are methods of spreading for Squamous cell vulvar carcinoma ?

Answer 61

1) Lymphatic embolization to regional LNs | 2) Hematogenous spread to distant sites (lung, liver, bone)

Question 62

While other type of vulvar carcinomas are rare, what is the second most common vulvar cancer (6% of vulvar cancer)?

Answer 62

Malignant melanoma

Question 63

What is a variant of squamous cell carcinoma and its lesions are cauliflower-like in nature can be confused with condyloma? What is contraindicated because it may induce anaplastic transformation?

Answer 63

1) Verrucous carcinoma | 2) Radiation

Question 64

__1__ gland carcinoma accounts for 1-2% of vulvar carcinomas and presents usually as a painless vulvar mass. Women over the age of __2__ should have biopsy of gland to exclude malignancy.

Answer 64

1) Bartholin | 2) 40

Question 65

What rare vulvar carcinoma appear as a rolled edge ulceration and they do not metastasize?

Answer 65

Basal cell carcinoma

Question 66

What preventative measure should decease the incidence of vaginal intraepithelial neoplasia (VAIN) and vaginal cancers in the future?

Answer 66

Gardasil vaccine

Question 67

The most common vaginal cancer is?

Answer 67

Squamous cell carcinoma

Question 68

What is required to confirm diagnosis of vaginal cancer?

Answer 68

Punch biopsy

Question 69

What is the main method of treatment for primary vaginal cancer?

Answer 69

Radiation

Question 70

When ____ 1/3 of vagina is involved the groin nodes should be included in treatment field or surgically removed.

Answer 70

Lower

Question 71

What rare vaginal cancer are metastatic usually from the cervix, endometrium, or ovary? Why type of this cancer is secondary to DES (diethylstilbestrol)?

Answer 71

1) Adenocarcinomas | 2) Clear cell adenocarcinomas

Question 72

What rare vaginal cancer has a mean age of 55 and usually occurs on the distal anterior wall?

Answer 72

Malignant melanoma

Question 73

What presents in girls less than 4 as a mass of grape-like polyps protruding from the introitus? Histologically the tumor is?

Answer 73

1) Sarcoma Botryoides | 2) Embryonal rhabdomyosarcoma

Question 74

The vagina is lined by what type of epithelium?

Answer 74

Nonkeratinized stratified squamous

Question 75

Lactic acid & Hydrogen peroxide producing ____ predominate and result in keeping the vaginal pH at 3.8-4.2.

Answer 75

Lactobacilli

Question 76

What are factors that can alter the protective microflora?

Answer 76

1) Antibiotics 2) Douching 3) Intercourse 4) Foreign body

Question 77

What is the most common cause of vaginitis? It is often polymicrobial but what is the most common organism?

Answer 77

1) Bacterial vaginosis | 2) Gardnerella vaginalis

Question 78

Bacterial vaginosis can cause a profuse __1__ discharge. Saline wet mount reveals presence of __2__. 10% KOH-positive whiff test releases __3__ like odor. Vaginal fluid pH is __4__.

Answer 78

1) Thin milky 2) Clue cells 3) Amine 4) Greater than 4.5

Question 79

____ 500mg BID x 7 days is used to treat bacterial vaginosis.

Answer 79

Metronidazole

Question 80

What is the second most common cause of vaginal infections? The most common cause of this is? Increased levels of what are a risk factor?

Answer 80

1) Vulvovaginal Candidiasis 2) Candida Albicans 3) Estrogen (high dose OCPs, pregnancy)

Question 81

For Vulvovaginal Candidiasis, the 10% KOH wet prep is positive for __1__. The vaginal pH is __2__.

Answer 81

1) Budding yeast | 2) Less than 4.5

Question 82

__1__ 150mg x 1 is used to treat Vulvovaginal Candidiasis along with vaginal application with synthetic __2__.

Answer 82

1) Diflucan | 2) Imidazole (miconazole, terconazole)

Question 83

What is caused by the flagellated protozoan T. Vaginalis?

Answer 83

Trichomoniasis

Question 84

Symptomatic cases of trichomoniasis reveal a ____ vaginal discharge.

Answer 84

Green-yellow “frothy”

Question 85

In the diagnosis of trichomoniasis, the saline wet mount reveals __1__. The pH is __2__. And the cervix is describes as __3__ appearing.

Answer 85

1) Motile trichomonads 2) Greater than 4.5 3) Strawberry