Benign And Malignant Vulva And Vagina

Question 1

VIN 3 usual type has 2 other associations?

Answer 1

Smoking and immunocompromised

Question 2

What does Paget’s disease of the vulva look like?

Answer 2

Fiery red background with white plaque like lesions, eczema look

Question 3

How does a squamous cell carcinoma lesion on the vulva usually present?

Answer 3

Itchy, raised, ulcerated and warty usually on labia majora

Question 4

How to manage vulvar squamous cell carcinoma?

Answer 4

Radical vulvectomy and take out regional lymph nodes, might need radiation and chemo after.

Question 5

What is the second most common vulvar cancer?

Answer 5

Malignant melanoma

Question 6

Where do we typically find malignant melanoma in the woman and how do we diagnose it?

Answer 6

Labia minora and clitoris

Wide local excision

Question 7

What is a variant of SSC in the vulva, what does the lesion look like, and what is contraindicated and why?

Answer 7

Verrucous carcinoma
Cauliflower looking
Radiation because it will become anaplastic

Question 8

What do we do with women who have a bartholin cyst?

Answer 8

If they are over 40, need biopsy to rule out bartholin gland carcinoma

Question 9

What’s the deal with vaginal neoplasia or cancers?

Answer 9

Primary is rare. More commonly comes from vulva or cervix

HPV

Question 10

How do we treat VAIN?

Answer 10

Excise it if it involves the vault

Multifocal lesions laser therapy or 5 flourouracil

Question 11

Symptoms of vaginal SCC, what might you see on physical exam, patterns of spread, required for diagnosis?

Answer 11

Abnormal vaginal discharge or bleeding, hematuria
Ulcerative, exophytic growth
Direct spread to bladder, rectum, urethra. Lymph and blood spread
Punch biopsy

Question 12

What is the main method of treatment for primary vaginal cancer, what do you need to do when lower 1/3 is involved, upper vagina is involved?

Answer 12

Radiation or chemoradiation
Treatment included groin nodes
Surgery

Question 13

3 rare vaginal cancers?

Answer 13

Adenocarcinoma
Malignant melanoma
Sarcoma botryoides (embryonal rhabdomyosarcoma)

Question 14

What is the most common cause of vaginitis, specific pathogen, 3 risk factors, and what do you do t treat it?

Answer 14

Bacterial
Gardnerella most common
Multiple sex partners, smoking and IUD
Metronidazole

Question 15

3 things to do when patient comes in with vaginal discharge?

Answer 15

Obtain info about the discharge (history)
Nitrazine paper for pH
Get sample and look under microscope

Question 16

What is considered diagnostic of bacterial vaginitis?

Answer 16

Clue cells in saline wet mount
KOH positive whiff test that smells like amine
Vaginal fluid pH over 4.5

Question 17

What is a clue cell?

Answer 17

Ep cell covered by gardnerella

Question 18

Second most common cause of vaginal infections, specific pathogen, risk factors, symptoms, diagnosis, treatment?

Answer 18

Yeast
Candida
Estrogen, DM, antibiotics, steroids, immunocompromised
Itchy, burning, pain cottage cheese like discharge
KOH for budding yeast
Diflucan

Question 19

Pathogen causing trichomoniasis, 1 risk factor, vaginal discharge, diagnosis, treatment?

Answer 19

T vaginalis
Unprotected sex
Green frothy discharge
Strawberry cervix 
Metronidazole